Hearing and otitis media with effusion in young adults with cleft lip and palate

Abstract Conclusion: Speech recognition in noise is affected when otitis media with effusion (OME) is present in young adults with unilateral cleft lip and palate. Objective: The objective of this study was to describe the hearing and performance on auditory tasks of young adults with unilateral cleft lip and palate as compared to young adults without cleft lip and palate. Methods: Twenty-six young adults with unilateral cleft lip and palate and 23 young adults without cleft lip and palate participated in the study. Pure tone audiometry, tympanometry, speech recognition in noise at the word and sentence level, and masking level difference were examined. Results: Results revealed elevated hearing thresholds in the young adults with cleft lip and palate as compared with young adults without cleft lip and palate. No differences concerning speech recognition in noise and binaural processing were observed between the young adults with cleft lip and palate and those without. However, there was poorer speech recognition performance in those adults with unilateral cleft lip and palate and OME on the day of testing as compared with young adults with unilateral cleft lip and palate without OME on the day of testing.     

Does the presence of a tracheoesophageal fistula predict the outcome of laryngeal cleft repair?

OBJECTIVE: To determine if the presence of a tracheo-esophageal fistula (TEF) alters outcome following laryngeal cleft repair. DESIGN: A retrospective review of patients diagnosed and treated for laryngeal clefts, with a minimum follow-up period of 1 year. SETTING: An academic tertiary care children's hospital. PATIENTS: Twenty-five pediatric patients diagnosed and surgically treated for laryngeal cleft. MAIN OUTCOME MEASURES: Each chart was reviewed to determine if patients with a laryngeal cleft had been diagnosed with TEF and had undergone a surgical TEF repair procedure. The success of the surgery was evaluated based on the resolution of symptoms and the endoscopic evaluation of the repair site. RESULTS: Twenty-five patients were reviewed for study purposes. Fourteen had a history of TEF repair and 11, no history of TEF. All 25 patients underwent surgical repair of the laryngeal cleft. Twelve of the 14 patients with a history of TEF repair experienced a breakdown of the laryngeal cleft repair. Only 1 of the 11 patients with no history of TEF experienced such a breakdown. In 8 of 9 patients with a laryngotracheoesophageal type I cleft, surgical repair was not successful. CONCLUSIONS: In our series, patients with laryngeal clefts who also had a history of TEF had a much higher incidence of breakdown of cleft repair compared with patients with no history of TEF. This finding is not conclusive and requires further investigation. The failure of cleft repair correlated with the severity of the cleft. The importance of these associations may lead to enhanced surgical planning and realistic preoperative family expectations.     

The older cleft palate patient. (A clinical otologic-audiologic study.)

A clinical study of 100 randomly selected cleft lip and/or palate adult patients, ages 14 to 77 years. Forty-nine out of 100 were otologically normal. Forty-two out of 100 were audiologically normal. A negative history of past ear disease is not an accurate screening method for abnormality. Auditory impairments (27 out of 58) suggesting a sensori-neural loss were found in relatively young adults. Is there a progressive degenerative sensori-neural hearing impairment in congenital cleft disease? Thirty-one out of 58 had conductive losses: these were correlated with the otologic findings on examination. Twenty-three out of 100 had had palatal pharyn-goplasty. The surgical procedure to reduce hypernasality probably does not aggravate the Eustachian tubal dysfunction. Approximately 50 percent of the congenital cleft lip and/or palate adults continue to have ear problems, probably for their lifetime.     

Outcomes for children with submucous cleft palate and velopharyngeal insufficiency

OBJECTIVE: To review the outcomes of children with submucous cleft palate who also have velopharyngeal insufficiency (VPI). METHODS: A retrospective chart review was carried out at a tertiary care academic centre of all patients who had VPI with a submucous cleft palate. The University of Iowa Cleft Palate registry parameters encompassing nasality (hyper- and hyponasality) were compared pre- and postoperatively. RESULTS: Preliminary results demonstrate a significant, stable improvement in children who underwent palatal surgery for VPI. CONCLUSION: Positive outcomes in the treatment of VPI in the submucous cleft palate population were demonstrated with a combined approach of speech therapy and palatal surgery.     

Prevalence of hearing loss in children with 22q11.2 deletion syndrome

ObjectiveThe purpose of this study was to determine the prevalence and characterize the types of hearing loss in pediatric patients with 22q11.2 deletion syndrome (22q11DS).MethodsFifty-eight patients were identified via retrospective chart review performed of patients with 22q11DS between 1996 and 2014. Patient demographics, pertinent family history, associated comorbidities, and degree and type of hearing loss were gathered for each patient. A literature review of the National Library of Medicine's database with a focus on hearing loss and 22q11DS was performed.Results22 patients (38%) were found to have hearing impairment: 68% with conductive hearing loss, 14% with sensorineural hearing loss, and 18% with mixed hearing loss. Patients with hearing loss regardless of type had a higher prevalence of developmental delay (55%), cleft palate (23%), articulation disorders (77%), and a greater need for tympanostomy tubes (73%) compared to patients with normal hearing. Temporal bone computed tomography scans of 5 patients revealed a variety of abnormalities in the middle and/or inner ears.ConclusionHearing impairment occurs in up to 38% of 22q11DS patients of both conductive and sensorineural types, with the conductive type being the most common. These patients have a greater need for tympanostomy tubes and a higher prevalence of developmental delay and speech articulation disorders. Early hearing screening and treatment is warranted in this population.     

Presentation of second primary cancers in young laryngeal carcinoma patients

Background: Laryngeal squamous cell carcinoma (LSCC) is rare in the young.

Objectives: We characterized the clinical behavior of LSCC and assessed the presentation of second primary tumors (SPCs) in this patient population.

Materials and methods: Data from the Finnish Cancer Registry (FCR) were used to identify an epidemiological series of LSCC patients diagnosed at the age of 40 years or under, during 1953–2012 in Finland. Data regarding primary treatment, survival, and SPCs were available. To further characterize the comorbidity and lifestyle factors of young patients with LSCC, institutional data were collected of patients treated at the Helsinki University Hospital during 1967–2012.

Results: We identified 151 patients, with a mean follow-up of 252 months. The 10-year overall survival (OS) was 75% and the disease-specific survival was 84%. SPCs were diagnosed in 26% (n?=?39), with a median delay of 28 years. Of the 35 patients in the institutional series from Helsinki, 22 (63%) were current or former smokers. LSCC recurred in 28% of patients.

Conclusions and Significance: The delay to SPCs in young patients was significantly longer compared with the general LSCC population. As factors underlying this phenomenon cannot be identified by this retrospective study, further studies are warranted.     

Benefits of cochlear implantation in early-deafened adults: the Toronto experience

OBJECTIVE: To present the results of a survey administered to a group of early-deafened cochlear implants adults and to report the level of perceived benefit. DESIGN: Prospective. SETTING: Large tertiary referral centre. METHOD: A 47-item questionnaire designed to evaluate cochlear implant use and benefit was sent to 42 early-deafened adult cochlear implant users. The questionnaire can be divided into seven subcategories: time of use, associated symptoms, communication, employment status and function, socialization, perceived benefit, and the impact on quality of life. Responses from 30 patients were received. RESULTS: The majority of our patients use their cochlear implant all of their waking hours. The majority of patients continue to depend on lip-reading and hearing as their main mode of communication, although they reported improved lip-reading skills with their cochlear implant. Twenty-three patients (76.7%) were employed. Eleven patients had a change in employment subsequent to cochlear implantation, nine (81.8%) of whom attributed this to their cochlear implant. Our patients als reported greater independence, a greater sense of safety in their environment, and an improved social life. Twenty-nine patients (96.7%) said that they were satisfied with their implant, 28 (93.3%) said that they would go through the same process again, and 27 (90%) said that they would recommend it to a friend in a similar situation. Twenty-nine patients (96.7%) stated that the cochlear implant has had a positive effect on their quality of life. Family and peer support, prior auditory-verbal therapy, and a positive attitude were the most commonly cited factors in successful cochlear implant use. CONCLUSIONS: Early-deafened adult cochlear implant users perceive significant benefit from cochlear implantation. Importantly, family and peer support, prior auditory-verbal therapy, and a positive attitude are considered important factors in maximizing this benefit.     

Language and independence in adolescents with and without a history of specific language impairment (SLI).

PURPOSE: Achieving behavioral independence is a key task of adolescent development. This 1 article of a companion set of 2 (the 2nd addressing the topic of parental perspectives) presents an investigation of the impact of language ability on independence. METHOD: Longitudinal and follow-up data from 120 adolescents with a history of specific language impairment (SLI), as well as concurrent data on a comparison group of 118 typically developing (TD) young people, are reported. Parental and self-report measures were used to examine independent functioning related to everyday living at the end of compulsory education (16 years of age). RESULTS: Adolescents with SLI are less independent than their TD peers, and level of independence is associated with poor early language and poor later literacy skills. CONCLUSION: Language and literacy play a larger role in adolescent independent functioning than nonverbal abilities in both TD adolescents and adolescents with SLI.     

Peritonsillarabszess

BACKGROUND: Peritonsillar abscess (PTA) is the most common deep neck space infection treated by otolaryngologists affecting predominantly young adults. Children present a challenge owing to the difficulty in obtaining an exact history and adequate physical examination. Particularly for the pediatric age group controversy surrounds the question of optimal treatment. This study was undertaken to evaluate bleeding complications following immediate tonsillectomy (TAC) in a pediatric population (<16 years) of age and to compare our management protocol with the current status in the literature. MATERIAL AND METHODS: The data of 218 children who had undergone TAC between January 1988 and January 2003 in our clinic were enrolled in a retrospective study. The youngest patient was 18 months, the oldest 15.9 years of age (mean: 14.53; median: 14; STD: 12.11 years). 95 patients were male (43.6%), 123 female (56.4%). Various treatment protocols of the current literature are addressed. RESULTS: Postoperative hemorrhage (all from the opposite side) requiring surgical treatment under general anesthesia occurred in 4 children (1.8%). Repeated hemorrhage did not occur, blood transfusions were not required, there was no case with lethal outcome. Several reports indicate that needle aspiration (NP) or incision and drainage (ID) may suffice for the majority of cases but do not distinguish between different treatments for children and adults. More recently, conscious sedation has become a great support for pediatric treatment protocols. CONCLUSIONS: The initial success rates of NP or ID are both very high (>90%) and the overall recurrence rate is low, particularly in children. Only for selected subgroups, patients may profit from TAC, which was clearly not associated with an increased risk of bleeding in our pediatric population.     

Unusual association of congenital middle ear cholesteatoma and first branchial cleft anomaly: management and embryological concepts

OBJECTIVE: To report two cases of an undescribed association of first branchial cleft fistula and middle ear congenital cholesteatoma and to discuss management and embryological hypothesis. DESIGN: Retrospective study and review of the literature RESULTS: Both patients were young girls free of past medical or surgical history. Surgical removal of the first cleft anomaly found in the two cases a fistula routing underneath the facial nerve. Both cholesteatomas were located in the hypotympanum, mesotympanum. In one case, an anatomical link between the two malformations was clearly identified with CT scan. DISCUSSION: The main embryological theories and classification are reviewed. A connection between Aimi's and Michaels' theories (congenital cholesteatoma) and Work classification might explain the reported clinical association.     

Medical profile of the language-delayed child: otitis-prone versus otitis-free

Delay in language development may be associated with an underlying anatomical, neurosensory, or psychological disorder such as: deafness, cerebral palsy, cleft palate, autism, or mental retardation. A condition called specific developmental language delay may occur in children devoid of any other identifiable disorder or developmental delay. Language delay associated with early onset, severe-to-profound hearing impairment has been well documented. Controversial studies have also appeared in the communicative disorders' literature suggesting that fluctuating conductive hearing loss in early childhood can significantly affect the development of language and related academic skills. Some authors have claimed that these deleterious effects can be irreversible. This study focuses on 3 groups of preschool children, in whom hearing acuity has been documented: One group with recurrent otitis and language delay; a second group with an equally well documented otitis history but without language delay; and a third group with documented language delay in the absence of any known predisposing conditions, including early-onset, recurrent otitis media. Prenatal, birth and developmental histories of the children in each group were compared in detail to identify any factors which may enhance or ameliorate the effects of fluctuating conductive hearing loss on language development. In a population of 1864 children (ages 9-59 months) referred for otolaryngologic and/or communicative evaluation, 480 otherwise normal children (67.6% males; 32.4% females) were found to have a history of early-onset, recurrent otitis media and/or delayed speech and language development on the basis of an extensive evaluation battery. This population was further subdivided into 3 groups (I = otitis-positive/normal language; II = otitis-positive/language delay; and III = otitis-free/language delay). Among the 329 children with positive histories for early otitis media (Groups I & II), a significantly higher percentage of those demonstrating language delay were from homes in the lower socio-economic category. Race and sex showed no significant relationship to language delay among the otitis-positive groups, although males were twice as numerous as females in the over-all study population. Articulation errors on speech measures and borderline delays in other developmental milestones (standing, walking, and toilet training) were also significantly greater in the language-delayed group when compared with otitis-positive children whose language was age-appropriate.(ABSTRACT TRUNCATED AT 400 WORDS)     

Outcomes of consonant-vowel monosyllable perception and word recognition after cochlear implantation in elderly Japanese patients

Conclusion: Performance in consonant-vowel (CV) monosyllable speech perception after cochlear implantation (CI) in the elderly (≥ 65 years) is equivalent to that of young adults (18–64 years). Present data in the Japanese language supported the indication for CI in the elderly. Word recognition after CI was significantly lower in the elderly than young adults. Objective: This study compared outcomes of monosyllable perception and word recognition after CI between elderly patients and young adults with post-lingual deafness. Age-related differences in CV monosyllable speech perception in Japanese were examined. Methods: A retrospective chart review of 137 patients with post-lingual deafness who underwent CI at Okayama University Hospital during 1992–2014 [young adults aged 18–64 years (n = 96) and elderly aged ≥ 65 years (n = 41) at implantation] was conducted. CV monosyllable speech perception post-CI was compared among age groups (18–29, 30–39, 40–49, 50–59, 60–69, 70–79, 80–89). CV monosyllable perception and word recognition scores post-CI were compared between the elderly and young adults. Results: There was no significant difference in CV monosyllable speech perception among age groups. CV monosyllable speech perception in the elderly (61.4 ± 25.5%) did not differ from that of young adults (65.9 ± 24.8%). Word recognition scores were significantly lower in the elderly (64.3 ± 28.1%) than young adults (80.4 ± 25.9%) (p < 0.05).     

Hearing levels and age in cleft palate patients

Tonal audiometry was used to compare hearing levels in patients with bilateral cleft lip and palate (BCLP) (57 patients), unilateral cleft lip and palate (UCLP) (124 patients) and isolated cleft palate (ICP) (62 patients), and according to age groups. Patients with isolated cleft palate showed greater improvement in hearing level with age than patients with UCLP and BCLP; as adults they showed the lowest frequency of ears with hearing level of less than 40 dB, and the highest frequency of ears with hearing levels of 11–20 dB. Patients with BCLP had a higher frequency of ears with a hearing level of 21–40 dB during early childhood and adult age than patients with ICP. Patients with UCLP and BCLP showed a slower decrease with age in the frequency of ears with hearing loss than patients with ICP; the hearing level in patients with UCLP and BCLP improved only in groups with hearing levels of 21–40 dB, while those with hearing levels above 40 dB showed no significant improvement with age.Conservative therapeutic methods for normalization of the hearing level and middle ear state were found to be inefficient in the cleft palate population Thus, early surgical treatment (ventilation tube insertion) appears to be the therapy of choice.     

Anticipated absence from work (‘sick leave’) following routine ENT surgery: are we giving the correct advice? A postal questionnaire survey

In the UK patients who undergo common ear, nose and throat (ENT) operations, and are employed, are advised to take 2 weeks sick leave before returning to their employment. A retrospective postal questionnaire survey (of adult patients who had undergone four common specific ENT operations) was conducted, to validate whether this preoperative advice given, was appropriate, and to attempt to assess the patient factors, which influenced the amount of postoperative absence from work. Among 218 questionnaires sent, 156 (71.6%) responses were returned and 132 (60.6%) were used. Analysis of the data for absence from work, showed that 58.3% had taken ≤ 2 weeks and 41.7% had taken > 2 weeks. The majority of patients (70.5%) stated that 2 weeks absence following their surgery was appropriate, whereas 5.3% reported that the period was excessive and 24.2% felt that it was inadequate. Postoperative pain (30.3%), infection (30.3%), bleeding (7.6%) and other causes (15.2%) were reported as the reasons for the delay to return to work. Nearly 31% of men and 55% of women had taken > 2 weeks of sick leave. In conclusion, the current practice of advising employed adults to take 2 weeks time off work following routine ENT surgery is appropriate. However, nearly 42% had taken > 2 weeks to return to their employment. Patients who underwent tonsillectomy and laser palatoplasty in general, required more time to recuperate prior to returning to work, when compared to those who had undergone septoplasty and functional endoscopic sinus surgery (FESS). Postoperative pain and infection were reported to be the main reasons for the delay in returning to work. Men, and self‐employed patients returned to work earlier than women and other employed groups.     

Anticipated absence from work ('sick leave') following routine ENT surgery: are we giving the correct advice? A postal questionnaire survey

In the UK patients who undergo common ear, nose and throat (ENT) operations, and are employed, are advised to take 2 weeks sick leave before returning to their employment. A retrospective postal questionnaire survey (of adult patients who had undergone four common specific ENT operations) was conducted, to validate whether this preoperative advice given, was appropriate, and to attempt to assess the patient factors, which influenced the amount of postoperative absence from work. Among 218 questionnaires sent, 156 (71.6%) responses were returned and 132 (60.6%) were used. Analysis of the data for absence from work, showed that 58.3% had taken 2 weeks. The majority of patients (70.5%) stated that 2 weeks absence following their surgery was appropriate, whereas 5.3% reported that the period was excessive and 24.2% felt that it was inadequate. Postoperative pain (30.3%), infection (30.3%), bleeding (7.6%) and other causes (15.2%) were reported as the reasons for the delay to return to work. Nearly 31% of men and 55% of women had taken > 2 weeks of sick leave. In conclusion, the current practice of advising employed adults to take 2 weeks time off work following routine ENT surgery is appropriate. However, nearly 42% had taken > 2 weeks to return to their employment. Patients who underwent tonsillectomy and laser palatoplasty in general, required more time to recuperate prior to returning to work, when compared to those who had undergone septoplasty and functional endoscopic sinus surgery (FESS). Postoperative pain and infection were reported to be the main reasons for the delay in returning to work. Men, and self-employed patients returned to work earlier than women and other employed groups.     

Hearing impairment among adults: The impact of cardiovascular diseases and cardiovascular risk factors

Objective: To investigate the influence of cardiovascular diseases on hearing impairment (HI) among adults. Furthermore, to seek other potential risk factors for HI, such as smoking, obesity, and socioeconomic class. Design: A cross-sectional, unscreened, population-based, epidemiological study among adults. Study sample: The subjects (n = 850), aged 54–66 years, were randomly sampled from the population register. A questionnaire survey, an otological examination, and pure-tone audiometry were performed. Results: Cardiovascular diseases did not increase the risk for HI in a propensity-score adjusted logistic regression model: OR 1.24, 95% CI 0.79 to 1.96 for HI defined by better ear hearing level (BEHL), and OR 1.48, 95% CI 0.96 to 2.28 for HI defined by worse ear hearing level (WEHL), in the 0.5–4 kHz frequency range. Heavy smoking is a risk factor for HI among men (BEHL: OR 1.96, WEHL: OR 1.88) and women (WEHL: OR 2.4). Among men, obesity (BEHL, OR 1.85) and lower socioeconomic class (BEHL: OR 2.79, WEHL: OR 2.28) are also risk factors for HI. Conclusion: No significant association between cardiovascular disease and HI was found.     

Late ear sequelae in cleft palate patients

This retrospective study looks at the incidence and nature of ear disease in 50 adolescent patients who had cleft palates repaired in infancy. Half of these patients had a history of grommet insertion. We found that most patients had normal hearing (81%) and middle-ear pressures (86%), although about half had tympanic membrane abnormalities. Grommet insertion did not result in better long-term hearing in this study but was strongly associated with tympanosclerosis. Cleft type did not influence the degree of ear disease although more patients with complete clefts had a history of repeated grommet insertion. Otitis media with effusion is almost universal in cleft palate infants and may influence later language, speech and educational development. At the time of palatal repair grommets should be inserted to improve hearing in these infants.     

良性阵发性位置性眩晕患者焦虑状态分析

目的 探讨良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者是否存在焦虑状态.方法 对58例确诊为BPPV的患者采用状态-特质焦虑问卷(state-trait anxiety inventory,STAI)进行问卷调查,并与国人标准常模进行比较,分析其是否存在焦虑状态及其程度,并对不同性别、年龄、受教育程度BPPV患者进行比较.结果 男、女性BPPV患者特质焦虑(T-AI)得分(分别为42.19±7.92、41.16±9.40分)与国人男、女性常模得分(分别为41.11±7.74、41.31±7.54分)差异无统计学意义(P值分别为0.539、0.924);但状态焦虑(S-AI)得分(分别为43.64±7.82、41.43±5.47分)高于国人男、女性常模(分别为39.71±8.80、38.97±8.45分),差异有统计学意义(P值分别为0.033、0.01).不同性别、年龄及受教育程度BPPV患者特质焦虑(T-AI)得分差异均无统计学意义(P值分别为0.674、0.349、0.077),但状态焦虑(T-AI)得分差异有统计学意义(P值分别为0.046、0.02、0.035),男性、老年、受教育程度较高的BPPV患者焦虑程度分别高于女性、中青年、受教育程度较低的患者.结论 BPPV患者存在焦虑情绪,但与常人相比无明显焦虑潜质;男性、老年、受教育程度较高的BPPV患者焦虑程度分别高于女性、中青年、受教育程度较低的BPPV患者.     

Audiometric, clinical and educational outcomes in a pediatric symptomatic congenital cytomegalovirus (CMV) population with sensorineural hearing loss

OBJECTIVE: To correlate audiometric findings and outcomes with the clinical, radiological and educational findings in a symptomatic congenital cytomegalovirus (CMV) population with sensorineural hearing loss. METHODS: A retrospective review of data from 21 symptomatic congenital CMV patients identified in a pediatric hearing impaired database of 1500 patients. Clinical data, audiometric thresholds and outcomes, radiographic abnormalities, communication and educational achievements were used as outcome measures. RESULTS: Twenty-one patients were identified with symptomatic congenital CMV infection at birth; 5 with unilateral hearing loss and 16 with bilateral hearing loss. The median initial pure-tone average (PTA) for the 21 subjects was 86 dB and the median final PTA was 100 dB. Progression of hearing loss was seen in 9 patients (43%). Neurological and radiological sequelae of symptomatic CMV infection were seen in 81% of affected patients. Children with neurological dysfunction were significantly more likely to rely on special education (p = 0.045). There was a significant correlation between the severity of the initial PTA and the development of a progressive hearing loss (p = 0.0058). Initial hearing thresholds were significantly better in those children with a history of jaundice (p = 0.002), hepatosplenomegaly (HSM) (p = 0.022) and cerebral palsy (CP) (p = 0.013). There was a significant correlation between a less severe final PTA and the presence of CP (p = 0.005). A history of mental retardation in children was significantly associated with poorer communication skills (p = 0.043). CONCLUSIONS: The severity of neurological manifestations in congenital symptomatic CMV infection was positively correlated with the need for total and manual communication and the reliance on special education. Statistical associations between clinical findings such as hepatic dysfunction, CP and hearing level were identified however plausible mechanisms explaining these associations remain ambiguous and are discussed in the context of this complex population of children with congenital symptomatic CMV.     

Rhinologic computed tomographic evaluation in patients with cleft lip and palate.

OBJECTIVE: To investigate the anatomical characteristics of the nasal cavity and paranasal sinuses in relation to the presence of sinusitis in patients with cleft lip and palate. DESIGN: Retrospective survey. SETTING: Tertiary care hospital. PATIENTS: Forty-seven consecutive patients with cleft lip and alveolus with or without cleft palate. MAIN OUTCOME MEASURES: The patients underwent computed tomographic scans of the maxilla, and the following parameters were evaluated: nasal septal shift from the midline, soft tissue density shadow of the maxillary sinus, cross-sectional area of the maxillary sinus, and height of the floor of the maxillary sinus. RESULTS: The nasal septum was convex to the cleft side in most of the patients with unilateral clefts, and there was a significant correlation between the cleft side and the direction of nasal septal deviation (P<.001). Sinusitis was more severe in the noncleft side than in the cleft side (P =.04), and in the concave side than in the convex side (P= .02). The cross-sectional area of the maxillary sinus was not statistically different between the cleft side and noncleft side, nor between the septal concave side and convex side. The floor of the maxillary sinus was situated higher in the cleft side than in the noncleft side (P = .02). CONCLUSIONS: The occurrence of maxillary sinusitis associated with cleft lip and palate is dependent on both the cleft side and the deviated nasal septum, but not on the size of the sinus. The cleft side is responsible for the direction of the septal deviation and the height of the floor of the maxillary sinus. A low-situated sinus floor may be in contact with the root of the teeth, and thus may be one of the etiologic factors of sinusitis in patients with clefts.