Ossiculoplasty in a patient with a cleft of the soft palate.

A 38-year-old man with a history of a cleft of the hard and soft palates, which had been repaired during childhood, presented with a right recurrent cholesteatoma. He had previously undergone two intact canal-wall tympano-mastoidectomies at another institution. Two years prior to presentation, he had undergone a canal-wall-down mastoidectomy with tympanoplasty. At that time, he received a total ossicular replacement prosthesis (TORP). During the short-term postoperative period, his hearing had improved. Over the succeeding 6 months, however, the tympanic membrane began to retract, and the patient reported that his hearing had deteriorated.

Computed tomography revealed that the ossicular prosthesis had become dislodged. Desquamated epithelium could be seen surrounding the oval window niche and the displaced prosthesis. The patient underwent a revision ossiculoplasty and received a titanium TORP; a long-term ventilation tube was also inserted into the pars tensa.

At the 1-year follow-up, the patient reported that his hearing was much improved. Although his audiogram showed a mixed hearing loss, he said he was able to use a standard telephone. Findings on otoscopic examination revealed that the prosthesis was in satisfactory condition (figure).

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The persistence of eustachian tube dysfunction in the face of repaired or unrepaired clefts of the soft palate poses a challenge with respect to hearing rehabilitation in this group of patients.

From the Department of Otolaryngology--Head and Neck Surgery, University of Texas Health Science Center at Houston.