Yang, McPherson 77 Asian J Oral Maxillofac Surg. Vol 19, No 2, 2007 Asian J Oral Maxillofac Surg. 2007;19:77-88. SPECIAL CONTRIBUTION © 2007 Asian Association of Oral and Maxillofacial Surgeons. Correspondence: Frank F Yang, Centre for Communication Disorders, University of Hong Kong, 5F, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong. Tel: (852) 2859 0598; Fax: (852) 2559 0060; E-mail: yangfeng@hku.hk Introduction Cleft lip and/or palate (CL/P) is a congenital anomaly of the lip, palate, or both that may appear in varying degrees of severity and configuration. Hearing impairment is a common comorbidity. The relationship of auditory problems and CL/P was first reported by Alt in 1878. 1 Research has found that patients with CL/P are more at risk of ear disorders, such as otitis media, tympanometric abnormalities, and consequent hearing loss. Pannbacker 2 found that 53.3% of 103 CL/P patients had hearing loss in either ear. Caldarelli 3 reported that 55% children with CL/P had otological problems. Hayes 4 used auditory brain stem response (ABR) to show that around 50% of 145 infants with CL/P showed at least mild bilateral hearing loss. Many factors, including sex, age, racial group, type of cleft disorder, and the repair status of the CL/P, may influence the prevalence of audiological problems in children with CL/P. Previous research has suggested that the prevalence of hearing disorders in western patients 5-7 with CL/P is higher (50% or more) than in Chinese patients in Singapore and Hong Kong, where it is likely to be less than 30%. 8-10 How- ever, this latter rate is still much higher than that for non-cleft children, which is reported to be up to 7% in normal children at 7 years of age. 11 Race was considered to be a possible reason for such differences. Investigations from other developing countries in Asia have, however, reported relatively high rates (50 to 80%) of hearing impairment in children with clefts. 12-14 The basic level of medical treatment for ear problems in these countries could account for such results. In India, Ramana et al 14 noted that 76.6% of patients with unrepaired cleft palate and older than 7 years demonstrated mild-to-moderate hearing impairment. Some research has noted that the hearing levels of western patients with cleft palate improved with age; while hearing loss in younger children was mainly moderate Assessment and Management of Hearing Loss in Children with Cleft Lip and/or Palate: a Review Frank F Yang, Bradley McPherson Centre for Communication Disorders, Cleft Lip/Palate Centre, University of Hong Kong/Prince Philip Dental Hospital, Hong Kong Abstract Hearing loss as a common comorbidity in children with cleft lip and/or palate has been well documented. Auditory impairment may contribute to abnormalities in speech, language and learning abilities, and other communicative disorders in children with oral clefts. The functional consequences of hearing loss in this group should not be underestimated. In this paper, the existing literature is reviewed with an emphasis on the prevalence, type, assessment, and management methods for hearing loss in children with cleft lip and/or palate. The prevalence of hearing disorders reported in western patients with cleft lip and/or palate is generally higher than in the eastern countries. However, hearing loss is common in children with cleft lip and/or palate of all ethnicities. Conductive hearing loss caused by middle ear disease is reported to occur frequently in syndromic and non-syndromic cleft cases. The prevalence of sensorineural hearing loss is relatively higher in syndromic clefts than non- syndromic clefts. Assessments of hearing loss in children with clefts should include case history taking and a detailed audiometric evaluation, and should be performed by otolaryngology and audiology professionals. Surgical treatment, including closure of clefts and ventilation tube insertion, is reported to be effective in reducing conductive hearing loss but this remains controversial. Non- surgical treatments for middle ear disease and hearing aids have also been suggested in recent studies. This review also highlights the possible role of central auditory processing disorder in the hearing loss of children with cleft lip and/or palate, and recommends the systematic study of central auditory processing in children with cleft lip and/or palate. Key words: Cleft lip, Cleft palate, Case management, Hearing loss, Language development disorders