Is it necessary to put ventilation tubes at the time of surgery in children with cleft palate?
Reviewed by Madhup K Chaurasia

It is commonly understood that existence of a palatal cleft is associated with abnormal action of tensor veli palatini muscle. Frequent middle ear effusions therefore occur because this muscle obstructs rather than opens the Eustachian tube on yawning and swallowing, and velo-pharyngeal insufficiency, with its tendency to route nasopharyngeal secretions towards the Eustachian tube opening, contributes to congestion at this spot. Against this is the concept that the time allowed to ‘settle’ after cleft palate surgery and verticalisation of the Eustachian tube with age may not necessitate routine insertion of ventilation tubes at the time of cleft palate surgery. Other factors requiring us to reconsider this practice are common infections, scarring and residual perforations that occur after ventilation. In this retrospective study, ventilation tubes were inserted at the time of surgery in children with indications to do so, and this formed Group 1. Group 2 comprised children who did not have grommets inserted. Both groups had a prolonged follow-up. In both groups, about half of these children did not need subsequent insertion of grommets, suggesting that ‘prophylactic’ insertion of grommets does not necessarily obviate the need for subsequent grommet insertion. There was no correlation of the laterality of middle ear effusion with the type of cleft palate, and this may be attributed to more generalised anatomical facial changes in cleft palate abnormality. Considering notable complications following grommet insertion, as known generally and observed in this study, the practice of ‘prophylactic’ grommet insertion at the time of cleft palate repair where prevalent, needs reviewing.

Cleft palate and ventilation tubes: a prophylactic dilemma.
Machado A, Santos M, Leitao B, et al.
JOURNAL LARYNGOL OTOL.
2023;137(5):501-5.