Background: The prevalence of chronic middle ear disease in patients after surgery for cleft palate is about 50%. Aim of the present study was to analyse its morphological and physiological causes to prevent chronic atelectatic otitis media or cholesteatoma.
Methods: 15 adult patients with cleft palate were examined using middle ear microscopy, pure tone audiometry, EMG of the tensor veli palatini muscle and MRI of the Eustachian tube.
Results: 8 of 15 patients had chronic middle ear disease. With 13 of 15 patients single motor unit action potentials could be recorded from the tensor veli palatini muscle. MRI of the Eustachian tube revealed two decisive observations in patients with chronic middle ear disease: in 4 patients the pterygoid hamulus could not be detected, in all otitis patients the continuity of tensor veli palatini muscle was interrupted or disturbed by medial or lateral fixation.
Conclusion: Chronic middle ear disease with cleft palate patients is basically caused by impaired muscular compliance of the Eustachian tube. Thus integrity of hamulus as well as tensor veli palatini muscle must become of crucial interest in cleft palate surgery.
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