Audiology and Hearing

Hearing in Cleft Children

Hearing is affected in child who is born with a cleft lip and palate.  Because the cleft palate affects how the muscles work with the tube that drains the middle ear, many children with a cleft will have fluid buildup in the middle ear. This tube is called the Eustachian tube.   

Babies need to hear their parents speak. When there is fluid in the middle ear, the child cannot hear well (muffled) and cannot learn to speak.   

An audiologist is a professional who specializes in hearing.  The audiologist uses special equipment to assess hearing.  When the testing shows that the child has difficulty hearing, the audiologist works with the ear surgeon and coordinates with the plastic surgeon.  

Usually at the time of the cleft reconstruction by the plastic surgeon, the ear surgeon exams the ear and places a small tube through the ear drum to help the fluid to drain.  

Role of an Audiologist

An Audiologist is a healthcare professional who evaluates, diagnoses, and treats patients with hearing, balance and other disorders of the auditory (hearing) system. At the Craniofacial Center, the audiologist will evaluate your child's hearing to ensure that it is within the normal hearing range. Once the evaluation is completed, a treatment plan is then personally created for your child to make sure that all of their ear and hearing needs are being met.

Our audiologist works closely with the plastic and ear surgeons, speech language pathologist, and psychologists to make certain that every child receives the best possible care. 


The goal is to make sure that your child maintains normal hearing as well as to quickly treat and manage any hearing loss that is identified.

Patient Populations

Our audiologist works with a wide variety of patient conditions from birth onwards. These conditions are:

  1. Cleft lip and palate 
  2. Microtia/ Atresia  
  3. Treacher Collins syndrome 
  4. Pierre-Robin syndrome  
  5. Patients with hearing loss and other auditory disorders 


There are three parts to the ear. The pinna (outer ear), middle ear, and the inner ear. The middle ear space starts at the tympanic membrane (ear drum) and contains the ossicular chain (3 middle ear bones) that are connected to the inner ear. The ears, nose and throat are all connected and are affected by each other which is why when you get a cold you can have symptoms in those areas.

The middle ear space is very sensitive to pressure change and for our ears to work at their best, the pressure in the middle ear space should be equal to that of the environment. Our system is constantly working to make that happen which is why when we encounter pressure changes, our ears pop. Children with cleft palate have difficulty keeping the pressure in their middle ear space equalized, this is why they are more likely to have fluid buildup in their middle ears. Your Eustachian tube is an opening that goes from the middle ear to the back of the throat. It opens and closes to help keep the pressure in the middle ear equalized (makes ear pop). There is a muscle in our palate (roof of the mouth) that makes the Eustachian tube open and close. If that muscle does not work well due to a cleft in the palate then pressure will build up in the middle ear space and then that area becomes filled with pressure/stuffy and that tissue in the ear space starts to ooze fluid /mucus. That fluid becomes trapped in the middle ear and can cause a temporary decrease in hearing.

Fluid Buildup

Fluid buildup can become infected and should be monitored and treated properly. If an infection occurs, your pediatrician or ear, nose and throat physician can prescribe antibiotics as a form of treatment. If your child has frequent fluid buildup and/or infections, pressure equalization tubes may be inserted into the ear drum, through a minor surgical procedure, to help with hearing as well as decrease the frequency of middle ear problems. If not treated properly, chronic middle ear disease (fluid buildup/infection) can lead to other ear disease and cause permanent hearing loss. 


Trouble hearing can affect a wide range of development, including speech and performance in school. There is a critical window for hearing development so we want to evaluate your child as early as possible. 

Ideally, every child should have a hearing test when they're born. This hearing test determines when the audiologist should first evaluate your child further. Hearing tests can be done on children as young as 6 months. In case your child doesn't have a hearing test when they're born, we can do a hearing test here, at the Craniofacial Center, before their first surgery as part of the pre-operative evaluation. 

As your child is growing up, if you see that they are having trouble speaking or hearing, or isn't speaking, please make an appointment to see our audiologist. It is never too early to get your child's hearing tested!

Hearing Tests 

At the initial visit, the audiologist will perform a series of simple tests to evaluate your child's hearing. The tests are structured like games to make them more fun and engaging. 

During the tests, the audiologist determines whether or not your child's hearing is in the normal range. Based on the results, the audiologist can create a plan to best suit your child. 


Early hearing tests and treatment are very  important for the best outcomes. There is a critical window of development for hearing during the early years of life.

For this reason, we follow-up frequently during the early years of life to monitor hearing and make sure your child's hearing is in the normal range. Depending on the age of your child follow-up windows vary from 6 months to once a year.

Caregiver Education

Our audiologist works closely with caregivers to make the process as simple and straightforward as possible. Our audiologist makes sure that caregivers are aware of signs to look for that indicate changes to hearing, hearing loss and the milestones your child should be reaching at their age. 

Even though it may be difficult, it is really important to look out for these signs and whether or not your child is meeting the milestones.