Yo-IFOS survey on hearing management in children with cleft

Introduction: Children with cleft palate face a high risk of otitis media with effusion (OME) and conductive hearing loss. This survey evaluated contemporary global practice patterns in hearing surveillance and management within this cohort. Methods: A 43-item cross-sectional survey was electronically distributed to international pediatric otolaryngologists between January and March 2026. The questionnaire evaluated surveillance protocols, OME interventions, tympanostomy tube (TT) preferences, alternative hearing rehabilitation, and institutional resource barriers. Results: Sixty-seven clinicians participated, primarily from university or tertiary healthcare settings (85.1%). 72.7% of the participants were from high-income countries, while 27.3% were from low- and middle-income countries. For OME management, TT insertion was the preferred first-line choice for 50.7%, though responses showed marked variation regarding timing of insertion. If surgery was unfeasible, 53.7% utilized hearing amplification as a first-line alternative. Most clinicians (85.1%) avoided Eustachian tube balloon dilatation. Intensive surveillance was adopted by 50.7% for syndromic cleft cases. Principal barriers to optimal care included prolonged appointment wait times (25.4%) and low family awareness (22.4%), despite 77.6% of respondents practicing in high-resource centers. Conclusion: Although otolaryngology and audiology surveillance is widely embedded in international cleft pathways, substantial variation across participating countries and regions persists regarding surgical indications, timing of TT insertion, and follow-up. These findings highlight a need for international consensus and evidence-based guidelines to standardize cleft-related hearing management and optimize long-term outcomes.