Tympanostomy tubes and bone-conduction hearing aids in children with cleft palate : intervention outcomes

Abstract

Children with cleft palate (CP) are highly susceptible to conductive hearing loss (CHL) due to chronic eustachian tube dysfunction (ETD) and middle ear effusion (MEE). Tympanostomy tubes (TTs), better known as grommets, and bone-conduction hearing aids (BCHAs) represent the most common interventions; however, direct comparative evidence in this population remains limited. This study involved a multiple case study design integrating quantitative and qualitative data analysis. Six children with CP, their caregivers, and nine healthcare professionals (HCPs), which included three ENT specialists, two audiologists, and four speech-language pathologists (SLPs), also participated in this study. Audiological and medical records provided secondary quantitative data of hearing thresholds and tympanometric outcomes, while semi-structured interviews explored lived experiences, clinical decision-making, and perceptions related to intervention effectiveness. Quantitative analyses showed improvements in aided hearing thresholds among children who used a BCHA, specifically the bone-anchored hearing aid (BAHA) softband, with stable aided performance over time. In contrast, TTs outcomes were perceived as beneficial but in the short-term, as often extrusion of TTs was followed by recurrence of MEE. Qualitative findings indicated that both intervention options supported speech and language development; however, HCPs viewed BCHAs as providing more stable and long-term hearing access in this cohort. Parents valued multidisciplinary team (MDT) support and empathetic communication but identified delays, inconsistent follow-up, and limited information at diagnosis as persistent challenges. Given the findings, the need for structured protocols, clearer MDT coordination, and improved information sharing within Malta’s clefthearing services is underscored.