SP02. Outcomes after First Myringotomy Tube Insertion in Children with Cleft Pathology Treated at an Approved ACPA Centre
Bibliographic record
Abstract
PURPOSE: Children born with cleft palate and/or lip (CP, CLP) have a high incidence of early and recurrent otitis media with effusion (OME) associated with hearing loss, due to impaired middle ear ventilation. Management consists of early myringotomy & tube insertion, often performed at the time of cleft palate repair. The literature indicates that tube insertion improves the hearing in short term, but there is minimal long-term differences when compared with children who did not have tubes inserted. Complications associated with the myringotomy & tube insertion include episodes of otorrhea, tympanic membrane perforation, recurrent OME with need for tube reinsertion and cholesteatoma formation. There is minimal evidence to indicate if the complications rate is higher amongst children with an orofacial cleft pathology (OFC) after initial myringotomy & tube. There is also no clear standard in terms of the adequate frequency and length of follow up period.Our aim is to determine the effectiveness, the prevalence and predictor factors for complications associated with the first insertion of myringotomy tubes in children with OFC when compared with non-OFC patients in an accredited ACPA centre. METHODS: This is a retrospective matched cohort 1:3 study using administrative data from CHEO Research Warehouse. The intervention group includes patients born with CP/CLP pathology (OFC cohort), had the cleft palate repair before 24 months of age and their 5th birthday was before 31/03/2020. The control group (non-OFC cohort) did not include any children with OFC and was matched on gender and date of birth ± 30 days. RESULTS: The OFC cohort had 56 patients and in the non-OFC cohort were matched to 168 patients. In the OFC cohort, 73.2% had tube insertions at the time of cleft repair and 26.8% afterwards; forty-two patients (75%) had at least another consequent surgery related to tube insertion with 39 patients having a total of 58 tube insertions (1 to 4 reinsertions). In the non-OFC group, 40% had consequent otologic surgery and 30% (51/168) had a total of 80 tube reinsertions (1-5 reinsertions). There was no difference in the incidence of otorrhea, tympanic membrane perforation, otalgia, cholesteatoma between the cleft cohort and the control. Median time to first tube reinsertion was 937 days in the OFC cohort and 720 days on the non-OFC cohort. The OFC cohort had more than twice the number of clinic follow up (p=0.001), especially for patients who did not require further tube reinsertion or with more than 2 reinsertions. Recurrent OME after the first tube insertion was a predictive factor for future reinsertion. CONCLUSION: Children with OFC pathologies have 2 fold increased risk of myringotomy tube reinsertion after the initial insertion when compared to non-OFC cohort in the first 5 years of life and with more than twice the number of follow up appointments when compared to non-OFC cohort. Despite the higher number of tube insertions in the OFC group, they did not have a significantly higher number of complications related to the tubes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".