If your child has a cleft palate, they will have been regularly assessed for any hearing issues from a young age by the Audiologist or Ear Nose and Throat (ENT) consultant with the Cleft Team. However, as the kind of hearing issues associated with cleft palate usually come and go, it could be that your child develops these issues again at a later age, so it’s important to watch out for this.
These problems can develop gradually, so your child may not be aware that they have problems with hearing. This is why regular assessment by a medical professional along with vigilance from parents is so important to identify and treat these issues.
If left untreated, hearing problems can affect a child’s speech and language development, as not only will they not be able to clearly hear others speaking correctly, but they will also be unable to correct their own pronunciation when they make mistakes. It can also lead to children not hearing or being able to follow instructions, and can be especially difficult in a school or nursery environment.
What hearing issues might my child have?
There are three kinds of reasons for hearing loss:
- Inner ear problems (sensorineural hearing loss, or nerve damage)
- Middle ear problems (conductive hearing loss)
- Outer ear problems (conductive hearing loss)
Conductive hearing loss can be treated by surgery or hearing aids. Children born with a cleft palate are vulnerable to hearing loss due to middle ear problems, specifically glue ear.
Glue Ear (Otitis Media with Effusion, or ‘OME’) is a common condition in children with a cleft palate.
This is thought to happen when the eustachian tube doesn’t function properly. The eustachian tube runs from the middle ear to the back of the nose and throat, and it works by equalising air pressure between these two areas, sort of like what happens when you “pop” your ears.
If it doesn’t work properly, there may be a difference in air pressure between the middle ear and the nose, and the lining of the middle ear produces a liquid which can thicken and make it hard for children to hear, as well as making them prone to earaches. This can make it especially difficult to hear quieter sounds, or to hear something when there is a lot of background noise.
Boys are more likely than girls to develop glue ear, as are formula-fed babies.
Glue ear is often temporary and can get better on its own, but sometimes treatment is needed.
“Our little one has glue ear, as do thousands of babies her age. The difference for us? We know about it. As she grows up she will be constantly medically monitored in a way that kids without cleft won’t be. We’ll know if she has hearing problems and will be able to take action. We’ll know if she has speech difficulties and will have the support we need. This is an advantage of having a child with cleft – at every step she’ll have holistic clinical care. As such, we want to celebrate it.”
- Do nothing.
- Surgical treatment (usually with grommets)
- Boost hearing (usually with hearing aids)
This can be an option if the glue ear is not too severe and if it seems likely that the child will grow out of it in the near future. Many children not born with a cleft develop glue ear, and for many of them this will be a valid option.
A child born with a cleft palate is much less likely to grow out of glue ear quickly. Speech and language development, learning and behaviour can all be affected if hearing is impaired over a longer period of time, so in the majority of cases something needs to be done.
There are 2 ways of treating glue ear surgically:
- Inserting grommets, which are tiny plastic tubes placed in the eardrum. They are basically artificial eustachian tubes (see above), as they work to equalise pressure in the back of the throat, nose and middle ear. Often these are inserted at the same time as palate repair surgery if necessary.
- An adenoidectomy (this is an operation to remove the adenoids, which is tissue between the back of the nose and the throat). This is not usually considered for children born with cleft palate, since it could affect the ability of the palate to form a seal with the back of the mouth and therefore affect speech.
It is thought that grommets could help prevent middle ear damage, since there is a possibility that long-term glue ear can cause ear damage if it is left untreated. They can help with earaches and do not require maintenance once they’re in.
However, there are also disadvantages. Inserting grommets requires an operation and therefore general anaesthetic, which is why they are often inserted during a palate repair or another surgery. Grommets often fall out as the eardrum heals (after around 6-12 months), and if the Glue Ear comes back another procedure under general anaesthetic to replace the grommets may be necessary, and this may happen several times. You may also be advised against letting your child swim in certain kinds of water, or to take certain precautions against letting your child’s ears come into contact with dirty water which may end up in the middle ear. In rare cases, grommets can cause infections, and occasionally perforations (holes) and scarring to the ear drum.
Using hearing aids can improve hearing without the need for surgery, and are usually suitable for children with any level of hearing loss.
However, as with grommets, there are disadvantages:
- Children can’t wear them all the time (e.g. in bed or when swimming).
- They require maintenance (new moulds as a child’s ears grow, batteries, someone needs to know how to turn them on and off and how to adjust volume settings).
- They are quite visible (however, younger children tend to cope with hearing aids very well in this respect. Their friends don’t tend to notice anything different about them).
- Hearing aids have no effect on middle ear disease.
It is possible to use grommets and hearing aids in combination, though this could increase the chances of infection. If this is the treatment option and the child does develop an infection, the grommets may have to be removed.
T-tubes (a larger type of grommet that is less likely to fall out) are sometimes used in older children, but they are too big for most small children and are also more likely to cause scarring and perforation.
Which should I pick?
It is important to treat hearing loss since it can have such a big impact on a child’s development.
However, it is not possible to say generally that one treatment is better than another. While they all have advantages and disadvantages, ignoring ongoing treatable hearing problems is by far the worse option.
Your Cleft Team may recommend one of these options, or they may give you a choice. Listen carefully to their reasons for recommending each one, and make a choice which is right for you and your child, keeping in mind the limitations and obligations that come with each.
Other treatments can include using decongestants or nasal sprays to clear out the middle ears. In the majority of cases, these problems clear up by around 6-8 years old, but occasionally they can lead to longer-term hearing issues which will be managed by your Cleft Team.
National Deaf Children’s Society (NDCS) – NDCS is a charity dedicated to deaf and hearing impaired children and their families throughout the UK. They have a detailed section of their site specifically about glue ear which includes a number of further resources.