The audiologist on the cleft and craniofacial team provides information regarding hearing sensitivity and mechanical function of the ears. Many syndromes with cleft lip and palate as a feature also have a risk for hearing loss. In addition, the function of the Eustachian tube (which connects the space behind the eardrum to the back of the throat) may be impaired by the cleft of the palate, putting the patient at increased risk for frequent ear infections. Stable hearing sensitivity is required for the proper development of speech and language. Children with cleft lip and palate are already at risk for speech and language problems due to anatomic abnormalities of the "articulators." For this reason, it is important to identify hearing loss early by monitoring their auditory sensitivity on a regular basis, in order to minimize complications of abnormal or fluctuating hearing on speech development.

1. Early Identification
   1. Newborn hearing screening: Techniques have been developed to test hearing regardless of age. Hospitals in many states routinely screen the hearing of all newborns. Diagnostic testing is performed in cases where the infant does not pass the screening test.
   2. High-risk testing: In states where universal screening is not available, children with craniofacial anomalies are tested because of their high risk for hearing loss status. Although specific test protocols will vary from one facility to another, "high risk" infants should be tested prior to age 4 months.
   3. Diagnostic testing: In cases where the infant does not pass the screening test, diagnostic testing will be performed in order to determine the severity of hearing loss as well as the type of hearing loss ("nerve deafness" vs. hearing loss due to ear infection), and whether the hearing loss is in one ear or both.
2. Management
   1. Sensorineural hearing loss, or "nerve deafness", is managed in most cases with hearing aids. The type of hearing aid recommended will depend upon the severity of hearing loss as well as any physical deformity of the external ear. In addition to amplification, early intervention educational services may be recommended with emphasis on language acquisition in light of the hearing loss.
   2. Conductive hearing loss due to ear infection or effusion will be managed by a physician, usually either the pediatrician or an otolaryngologist. Once the infection is appropriately treated, the hearing should return to normal. Conductive hearing loss due to anatomical abnormality of the mechanical structures of the ear may be managed by surgery, amplification, or a combination of the two.
3. Monitoring
   1. Sensorineural hearing loss. Children with cleft lip/palate and sensorineural hearing loss should be tested every 4-6 months in order to assess any progression of hearing loss and to make adjustments to amplification as needed for proper fit as the child grows.
   2. Conductive hearing loss. In cases of conductive hearing loss periodic assessment will assist the managing physician by providing feedback regarding the efficacy of treatment in achieving and maintaining normal hearing status.

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