Background & objectives : Hearing impairment is one of the associated problems seen particularly in children with cleft palate rather than cleft lip alone. This has received very little attention in the area of cleft care although research shows that hearing impairment affects language development The present study was carried not to find out the type and pattern of audiogram in cases attending a speech camp, average degree of hearing loss and its relation to the side of cleft, and the acoustic immittance findings and its relation to the otológica! evaluation. The parental awareness about the hearing problem was also assessed.

Methods : The study was conducted on cleft palate patients attending a speech camp. In all, there were 43 patients (19 males and 24 females) in the age range of 3-22 yr. All had undergone audiological assessment, speech and language evaluation, and otológica! evaluation using standard procedures.

Results : Hearing loss was seen in 38 (88.38%) patients. It was the first audiological assessments they ever had. The average pure tone Thresholds revealed a reverse-ski pattern with a wide air-bone gap. The degree of hearing loss ranged from 25 to 68 dB indicating that untreated otitis media resulted in moderate to moderately severe degree of hearing loss. The immittance findings supported the extent of extracranial complications identified on otoscopie examination. There were more patients with unilateral cleft of the left side with greater hearing loss in the ear alongside the cleft.

Interpretation & conclusion : Hearing loss is prevalent in more than three - forth of the patients attending the speech camp. There is a need for early identification and intervention of middle ear effusion for all cleft palate cases.

Key words Audiogram - cleft palate - hearing impairment - immittance - pure - tone threshold - speech camp

Cleft lip and palate is one of the common referred to a speech and hearing clinic. Cleft of the palate or both has a birth prevalence rate ranging 1/1000 to 2.69/1000 amongst different parts of world1. Asians are at highest risk than Caucasians blacks. The sex distribution shows a tendency of males being more affected than females. The ratio of primary and secondary cleft to bilateral clefts is Among unilateral clefts, left side cleft is reported to more common than right side cleft1″3. It is a congenital condition and is said to occur during the first 12 wk of gestation. Hearing impairment is one of the associated problems seen particularly in children with cleft palate rather than cleft lip alone,

The part of the ear, which is usually, affected in a child with cleft palate is the middle ear. Ingenerai, 100 per cent of the children by age seven must have suffered from atleast one episode of otitis media/middle ear effusion4. Usually by age 6 or 7 yr, as anatomical development of the face takes place superior-inferiorly, the Eustachian tube assumes a diagonal shape from its horizontal shape, observed in infancy. With change in shape, infection from the throat does not have a direct access. Thus the problem of middle ear infection and blocked Eustachian tube tends to decrease with age. Cleft palate is one of the high risk factors for otitis media. The incidence in such children is as high as 100 per cent5·6. This condition, known as middle ear effusion continues to exist for several years if left untreated.

Common complications associated with otitis media are more insidious in nature. The complications may be extracranial/intracranial. The degree of hearing loss is directly proportional to the amount of fluid present. The average hearing loss ranges from 15 to 45 decibel hearing level (dB HL). Sensori-neural hearing loss may also result due to inflammatory toxins diffusing through the round and oval window membranes resulting in serous labyrinthitis/organ of corti damage7.

Little attention has been paid to the implication of otologic histories in individuals with cleft palate, although hearing impairment affects the overall development of a child. We therefore undertook this study to find out or investigate the type and pattern of audiogram in cleft lip and palate subjects attending a speech camp, the average degree of hearing loss and its relation to the side of cleft and to assess the acoustic immitance findings and compare its relation to the otological evaluation. The parents were also assessed for their awareness about hearing problem in their children.

Material & Methods

Subjects: The subjects included in this study were children and adults who attended the speech camp “Cleft Palate to Clear Speech” organized at Ali Yavar Jung National Institute for the Hearing Handicapped, Southern Regional Centre (AYJNIHH, SRC), Secunderabad, in collaboration with the Department of Plastic Surgery, Nizam’s Institute of Medical Sciences (NIMS), Hyderabad, and Reconstructive Surgery Foundation - Earthspeak, U.S.A. In this camp, pre- and post-operative assessment of speech, the surgical intervention and need for second surgery were decided for these subjects. The children who could benefit from speech therapy were trained using the corrective babbling approach8 for a period of one week.