Babies born with a cleft palate often have a conductive hearing loss due to the opening in
the palate. Your baby will be seen regularly by an audiologist to monitor their hearing.
Audiologists are healthcare professionals who specialize in hearing and balance difficulties.
In this video, you will hear about audiology and what to expect with your child's ears
and their hearing when they have a cleft palate. First let's go over some ear anatomy.
There are three main parts to the ear: the outer ear, the middle ear, and the inner ear. The outside
of your ear, also called the pinna, captures sounds and funnels them down the ear canal
all the way to the eardrum, or tympanic membrane. Your middle ear is made up of several parts.
The first part is your eardrum. Sound captured by the pinna, and funneled down the ear canal, causes
the eardrum to vibrate. This vibration causes the three tiny bones behind the eardrum to move.
Another part of the middle ear is the eustachian tube. This tube connects the middle ear to the
upper throat and the back of the nose. It helps to equalize the pressure in the middle ear.
Mucus or congestion from the mouth and nose can travel through the eustachian tube and sit in
the middle ear behind the eardrum. This may cause some hearing difficulties which we will discuss
in a moment. The final part of the ear, the cochlea or organ of hearing, is designed like a rolled up
piano. The third bone in the middle ear, the stapes, vibrates into the cochlea. There are little hair
cells inside the cochlea, which function like piano keys and move when stimulated by different sounds.
When a hair cell moves, an electrical signal is sent to the auditory nerve which carries it up
to the brain. And that is how we hear sound. Babies born with a cleft palate are at risk
for developing what is called a conductive hearing loss. This type of hearing loss happens when there
is a problem in either the outer ear or the middle ear. Sometimes it can be both. Because there is an
opening in the palate, mucus or congestion is able to travel easily between the mouth, nose, throat
and ears. With mucus or congestion in the middle ear, sound cannot reach the cochlea as well as
it normally does. This results in what is called a conductive hearing loss. A conductive hearing loss
caused by congestion will generally range from mild to moderate in degree. Everyday speech may
sound a little bit muffled. Many children with a cleft palate, and evidence of a conductive hearing
loss, will have a ventilation tube inserted into their eardrum. The tube is tiny and usually falls
out on its own in six to 12 months. The hole in the eardrum will naturally heal and close on its own.
A doctor that specializes in ear nose and throat problems, called an otolaryngologist
or ENT, will assess if a tube needs to be inserted into your child's eardrum.
If a tube is needed, the procedure is usually done at the same time as the palette repair.
Your cleft lip and palate, or CLP team, will coordinate these appointments.
The first ENT visit is usually scheduled when your child is about nine months of age.
Once the tube is inserted, it will help drain out the fluid that has collected in the middle ear.
ENT and audiology will monitor the status of your child's hearing after the tubes have been inserted.
In most cases hearing returns to normal. All newborn babies can have their hearing
screened by Ontario's Infant Hearing Program or IHP. IHP locations are designated by the
family's home address. Hearing screening should be done at the location closest to your home.
Your local IHP location will work with your CLP program to coordinate audiology care.
An IHP screener or nurse will run a quick and automatic test in each ear that will provide
the result of either pass or refer. If your child receives a referral result
they will be sent for a diagnostic hearing test through their local IHP.
If your child receives a referral result in one or both of their ears, then additional testing
will be needed. Your child may be scheduled for a diagnostic auditory brainstem response test
or what we call an ABR. This test measures the brain's response to sound and checks.
The health of the entire auditory pathway to determine whether or not there is a permanent
hearing loss. This would be scheduled for the next available appointment at your local IHP location.
Your child will continue to have regular audiology follow-up appointments. Follow-up is to monitor
your child's hearing and to make sure that they continue to have good access to sounds from both
ears as they continue to develop. If your child had tubes inserted, then the audiology appointments
will be scheduled at the same time as the ENT appointments. If no tubes were needed, then the
audiology appointments will be scheduled on the same day as other appointments for your child.
So to summarize, at birth your child will have a newborn hearing screen at their local
IHP location. If they pass, then they will have a follow-up hearing test when they are nine months
old, scheduled by the CLP program. If they receive a refer, then they will have immediate follow-up
scheduled by their local IHP location. When your child is nine months old, they will have
a pre-palate repair hearing test scheduled by the CLP program. And then when your child is 15
to 18 months old they will have a post-palette repair hearing test, scheduled by the CLP program,
in coordination with the local IHP. Follow-up hearing tests for your child will be scheduled
by the CLP program at the same time as their ENT appointments. Regular audiology monitoring can
often be arranged locally and closer to home to minimize travel to and from the hospital.
Thank you for watching this video. We are here to help. If you have any questions,
or need further tips, please contact your child's audiologist or CLP team.
Thank you.