Your child’s hearing
Your child may experience some hearing impairment as a result of being born with a cleft palate. This does not always happen, but the possibility exists and your child’s hearing should be checked at approximately 12 months of age. Poor hearing can adversely effect the development of your child’s speech. This is because a child can only imitate the sound it hears. Consequently you must be aware of this possibility so that your child is not deprived of full learning ability in his/her early years. If your child has a cleft lip only, hearing problems will not arise consequent on the cleft.
What can go wrong?
Problems arise due to the connection between the muscles of the eustachian tube and the soft palate at the back of the mouth. During surgery to repair the palate, some of the muscles connected with the eustachian tube are divided and used in the palate repair. Consequently the Eustachian tube may not work properly and air will not get into the middle ear as readily as it should and its place is taken by fluid. This fluid interferes with the conduction of sound through the middle ear and your child may become ‘hard of hearing’. The problem most commonly arises in your child’s earlier years when the Eustachian tube has a more horizontal position. The tube becomes more sloped by the age of 6 or 7 years as the shape of your child’s face changes with the result that the problem tends to decrease.
The signs of hearing loss
Hearing loss can be difficult to detect in the very young child. Unresponsiveness, frustration or withdrawal can all be symptomatic of ear infection resulting in poor hearing. Turning up the sound of the television or having to repeat yourself can be other clues as to the existence of a problem. Particular attention should be paid to your child’s hearing in the first 2-3 years of life. Hearing tests will be carried out as part of the work of the combined cleft team, and you should not hesitate to contact the team and relay any concerns you may have with regards to your child’s hearing.
Treatment involves day case surgery, the administration of a general anaesthetic, and the draining of fluid with the insertion of a grommet. The grommet may last 6-9 months after which point they usually expel naturally. Grommets may need insertion on more than one occasion until such time as your child’s Eustachian tubes start to work properly.
You should generally notice an improvement in your child’s hearing within a few days. Swimming is now generally allowed for children with grommets in place if certain precautions are taken. Your ENT surgeon will advise you accordingly.