Babies with a cleft in the palate are much more likely to develop glue ear. This may result in difficulties with hearing if untreated, which in turn may delay and impair the development of normal speech.
The part of the ear that can be affected in a child with a cleft palate is the middle ear. Normally the middle ear contains air. It is connected to the back of the nose via the Eustachian tube. This tube opens and closes and permits air to enter the middle ear from the nose, thus keeping the air in the middle ear at the same pressure as the outside world.
If the Eustachian tubes do not function and air does not enter the middle ear regularly, then fluid is secreted into this area and interferes with the movement of the ossicles (three tiny bones in the middle ear). Therefore sound cannot travel efficiently across the middle ear, producing a reduction in hearing. This fluid can clear on its own but is referred to as glue ear if it persists for three months or more.
No child is too young for a hearing test. Your baby’s hearing will be tested shortly after birth as part of the Universal Neonatal Screening Programme. Testing can be repeated around the age of eight months, prior to any planned palate surgery. Thereafter, it will be tested as necessary.
Why do children with cleft palate get glue ear?
When there is a cleft in the palate, hearing problems can arise due to the muscles in the soft palate not functioning correctly.
These muscles move when we yawn, eat or swallow and they pull open the Eustachian tube to allow passage of air into the middle ear. If this does not happen then the Eustachian tube’s function is impaired and hearing problems can occur. It is not known how many children with a cleft palate this may affect.
The Ear Nose and Throat (ENT) specialist will supervise this and monitor your child’s progress, advising on treatment.
How will I know if my child has hearing problems?
Every child with a cleft palate should have extra attention paid to their hearing. Parents and teachers are usually the first to realise that a problem may exist. Indications of possible hearing loss may include:
- Turning up the sound of the television.
- Having to repeat oneself to a child when speaking.
- Inability of a child to hear the parent when called from another room.
In the under two-year old age group, it is more difficult to detect this loss. If you have any concerns about your child then you can discuss it with the ENT specialist.
What is the treatment?
Glue ear is often treated with grommets (tiny plastic tubes that are inserted into the eardrum). Sometimes a hearing aid may be suggested instead, particularly if glue ear is a recurrent problem.
For more information, see:
- Grommets surgery for glue ear (pdf on Oxford University Hospitals website)
- Aftercare following insertion of grommets (pdf on Salisbury NHS website)
- Myringtotomy with or without grommets (pdf on Salisbury NHS website)
What can my child hear?
You can get an idea of what your child’s hearing might be like by listening to this video:
How might hearing loss affect my child?
For more information about hearing loss, you may find the following links useful:
- National Deaf Children’s Society website
- Harvey gets grommets (National Deaf Children’s Society website)
When a child has a cleft lip only, glue ear may occur (as in any other child) but not as a result of the cleft.