Among nonsyndromic clefts of the lip and palate, which type of hearing loss is most common?

• A. Conductive
• B. Sensorineural
• C. Congenital
• D. Mixed

Answer: (A)

The key idea is that middle-ear problems are the most common hearing issue in nonsyndromic cleft lip/palate, causing conductive hearing loss. In children with cleft palate, the tensor veli palatini muscle that opens the Eustachian tube often doesn’t work well, leading to poor ventilation of the middle ear and frequent otitis media with effusion. Fluid in the middle ear interferes with the transfer of sound from the eardrum to the inner ear, so air-conduction hearing is reduced while bone-conduction hearing remains relatively intact, which is characteristic of conductive loss. Tympanometry in these cases often shows a type B curve with reduced or absent tympanic membrane mobility, consistent with middle-ear effusion.

Sensorineural hearing loss would involve the inner ear or auditory nerve and is not the typical pattern associated with nonsyndromic cleft lip/palate. Congenital describes when the loss is present from birth but doesn’t specify the type. Mixed loss would require both conductive and sensorineural components, which is less common in this population.