Effects of maxillary expansion on hearing and voice function in non-cleft lip palate and cleft lip palate patients with transverse maxillary deficiency: a multicentric randomized controlled trial

Abstract Introduction The association between the treatment of transverse maxillary deficiency and the recovery of hearing and voice functions has gained attention in recent years. Objective This prospective controlled trial aimed to evaluate the effects of rapid maxillary expansion on hearing and voice function in children with non-cleft lip palate and bilateral cleft lip palate with transverse maxillary deficiency Methods 53 patients (26 non-cleft and 27 bilateral cleft lip palate; mean age, 11.1 ± 1.8 years) requiring rapid maxillary expansion for correction of narrow maxillary arches were recruited for this trial. Eight sub-groups were established based on the degree of hearing loss. Pure-tone audiometric and tympanometric records were taken for each subject at four different time periods. The first records were taken before rapid maxillary expansion (T0), the second after expansion (T1) (mean, 0.8 months), the third after three months (T2) (mean, 3 months) and the fourth at the end of retention period (T3) (mean, 6 months). ANOVA and Tukey HSD post-hoc tests were used for data analysis. Additionally, voice analysis was done using an updated PRAAT software program in a computerized speech lab at T0 and T2. A paired-samplet-test was used for comparisons of mean values of T0 and T2 voice parameters within both groups. Results Rapid maxillary expansion treatment produced a significant increase in the hearing levels and middle ear volumes of all non-cleft and bilateral cleft lip palate patients with normal hearing levels and with mild conductive hearing loss, during the T0-T1, T1-T2, T0-T2, and T0-T3 observation periods (p < 0.05). The significant increase was observed in right middle ear volumes during the T0-T1, T0-T2 and T0-T3 periods in non-cleft patients with moderate hearing loss. For voice analysis, significant differences were observed only between the T0 and T2 mean fundamental frequency (F0) and jitter percentage (p < 0.05) in the non-cleft group. In the cleft group, no significant differences were observed for any voice parameter between the T0 and T2 periods. Conclusion Correction of the palatal anatomy by rapid maxillary expansion therapy has a beneficial effect on both improvements in hearing and normal function of the middle ear in both non-cleft and bilateral cleft lip palate patients. Similarly, rapid maxillary expansion significantly influences voice quality in non-cleft patients, with no significant effect in BCLP patients.

摘要：近年来，上颌横向发育不足的治疗与听力、语音功能恢复之间的关联已受到学界广泛关注。
研究目的：本前瞻性对照试验旨在评估上颌快速扩弓（rapid maxillary expansion）对非唇腭裂（non-cleft lip and palate）及双侧唇腭裂（bilateral cleft lip palate, BCLP）伴上颌横向发育不足患儿的听力与语音功能的影响。
研究方法：本研究共纳入53例因上颌牙弓狭窄需行上颌快速扩弓治疗的患者，其中非唇腭裂患者26例、双侧唇腭裂患者27例，平均年龄为11.1±1.8岁。根据听力损失程度将受试者划分为8个亚组。分别于4个时间点对每名受试者进行纯音测听及鼓室测压检查：首次检查于上颌快速扩弓治疗前（T0），第二次于扩弓治疗后（T1，平均0.8个月），第三次于治疗后3个月（T2，平均3个月），第四次于保持期结束时（T3，平均6个月）。数据分析采用方差分析（ANOVA）及Tukey HSD事后检验。此外，于T0及T2时间点，在计算机语音实验室中使用更新版PRAAT软件开展语音分析；两组内T0与T2的语音参数均值比较采用配对样本t检验。
研究结果：在T0-T1、T1-T2、T0-T2及T0-T3观察周期内，上颌快速扩弓治疗可使听力正常及轻度传导性听力损失的非唇腭裂与双侧唇腭裂患者的听力水平及中耳容积显著提升（p<0.05）。对于中度听力损失的非唇腭裂患者，其右耳中耳容积在T0-T1、T0-T2及T0-T3周期内均出现显著升高。语音分析结果显示，非唇腭裂组仅在基频（F0）均值及基频微扰百分比方面，T0与T2时间点存在显著差异（p<0.05）；双侧唇腭裂组的所有语音参数在T0与T2时间点均未观察到显著差异。
研究结论：上颌快速扩弓治疗可矫正腭部解剖结构，对非唇腭裂及双侧唇腭裂患者的听力改善与中耳功能正常化均具有积极作用。同样，上颌快速扩弓可显著影响非唇腭裂患者的语音质量，但对BCLP患者无显著影响。