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Orthod Craniofac Res. 2017 Jun;20 Suppl 2:8-18. doi: 10.1111/ocr.12184.

Centre-level variation in outcomes and treatment for otitis media with effusion and hearing loss and the association of hearing loss with developmental outcomes at ages 5 and 7 years in children with non-syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 2.

Author information

1
Life and Health Sciences, Aston University, Birmingham, UK.
2
Children's Hearing Centre, St Michael's Hospital, Bristol, UK.
3
National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK.
4
Bristol Dental School, University of Bristol, Bristol, UK.
5
School of Social and Community Medicine, University of Bristol, Clifton, Bristol, UK.
6
Department of Applied Statistics, Helwan University, Cairo, Egypt.
7
North Thames Regional Cleft Service, Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK.

Abstract

OBJECTIVES:

To explore centre-level variation in otitis media with effusion (OME), hearing loss and treatments in children in Cleft Care UK (CCUK) and to examine the association between OME, hearing loss and developmental outcomes at 5 and 7 years.

SETTING AND SAMPLE POPULATION:

Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK.

MATERIALS AND METHODS:

Children had air and bone conduction audiometry at age 5. Information on grommet and hearing aid treatment was obtained from parental questionnaire and medical notes. Hearing loss at age 5 was defined as >20 dB in the better ear and history of OME and hearing loss was determined from past treatment. Children with sensorineural hearing loss were excluded. Associations were examined with speech, behaviour and self-confidence at age 5 and educational attainment at age 7. Centre variation was examined using hierarchical models and associations between hearing variables and developmental outcomes were examined using logistic regression.

RESULTS:

There was centre-level variation in early grommet placement (variance partition coefficient (VPC) 18%, P=.001) and fitting of hearing aids (VPC 8%, P=.03). A history of OME and hearing loss was associated with poor intelligibility of speech (adjusted odds ratio=2.87, 95% CI 1.42-5.77) and aspects of educational attainment.

CONCLUSIONS:

Hearing loss is an important determinant of poor speech and treatment variation across centres suggest management of OME and hearing loss could be improved.

KEYWORDS:

centralization; developmental outcomes; hearing loss; unilateral cleft lip and palate

PMID:
28661080
DOI:
10.1111/ocr.12184
[Indexed for MEDLINE]

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