To the Editor I read with great interest the article by Smillie et al.1 However, I found a number of important issues that must be addressed. First, the authors concluded that their findings are the best evidence to measure the effect of cleft lip and/or palate (CLP) on complication rate. Given that several important complications (eg, eardrum perforation) are not analyzed in the study, the uncertain evidence requires further assessment. In the literature, another 2 studies also included age-matched, healthy control children for a comparison of the post–ventilation tube insertion (VTI) complications.2,3 One controlled prospective study3 showed that the prognosis of the children with CLP was as favorable as that of those without CLP, while the other study2 reported contradictory results, with a higher rate of complications in the children with cleft conditions. Hence, I believe the evidence remains inconclusive regarding the difference in the rates of complications.
Chin-Lung Kuo. A Critical Appraisal of Ventilation Tube Insertion in Children With Cleft Palate. JAMA Otolaryngol Head Neck Surg. 2015;141(2):189–190. doi:10.1001/jamaoto.2015.35