For Parents
Why children with cleft palate or craniofacial syndromes often have hearing problems – and what helps.
Children with cleft palate or certain craniofacial syndromes more often have problems with their ears – above all middle-ear effusion (fluid behind the eardrum), which can temporarily reduce hearing. Regular hearing checks are therefore important, because good hearing supports speech development. Many of these problems can be treated well.
The middle ear is ventilated through the so-called Eustachian tube. With a cleft palate, the muscle that opens this tube often does not work optimally. As a result, fluid frequently builds up in the middle ear – a middle-ear effusion.
A middle-ear effusion is usually not painful, but it can temporarily reduce hearing. Because good hearing is important for speech development in the first years of life, hearing is usually monitored closely in children with a cleft.
With some craniofacial syndromes, the ossicles, the ear canal or the outer ear may also be formed differently. This particularly affects children with hemifacial microsomia or Treacher Collins syndrome.
A middle-ear effusion often clears up on its own. If it persists and affects hearing, the care team may suggest small ventilation tubes (grommets), often placed during surgery that is planned anyway. Whether and when this is sensible is decided individually by the ENT and care team.
If hearing is permanently reduced, there are various forms of support. With a conductive problem – for example if the ear canal is narrow or absent – a bone-anchored or skin-worn hearing system (e.g. BAHA) may be an option. Which solution fits depends on the individual findings and is discussed within the specialist team.
If your child responds less well to sounds, stalls in speech development, often speaks very loudly or turns the TV up high, talk to the care team or the ENT specialist. A hearing assessment provides clarity.
That children with cleft palate more often have effusions and temporary hearing reduction, and that regular hearing checks are sensible, is widely accepted.
Whether grommets are placed routinely or only for persistent effusion is handled differently between centres.
The long-term benefit of early, routine grommet placement compared with a watchful approach is still being studied.
We advise parents and professionals – confidentially and in your language.
Get in touchWith a cleft palate the muscle that opens the Eustachian tube often does not work optimally. This ventilates the middle ear less well and fluid frequently collects (middle-ear effusion), which can temporarily reduce hearing. Regular hearing checks are recommended.
A middle-ear effusion is fluid behind the eardrum. It is usually not painful and often clears on its own, but it can temporarily reduce hearing. If it persists, the care team may consider ventilation tubes. The decision is made individually.
Not necessarily. Many reductions in hearing are temporary. If hearing is permanently reduced, there are various forms of support depending on the findings, from grommets to special hearing systems. What fits is clarified by the specialist team.
The care team decides individually. In children with a cleft or craniofacial syndrome, regular, age-appropriate hearing tests are usual, to support speech development.