Rapid Maxillary Expansion, Sleep-Disordered Breathing and Conductive Hearing Loss in Children: A Correlation

Aim: To evaluate the effects of Rapid Maxillary Expansion (RME) with respect to improvement in sleep disordered breathing(SDB) and conductive hearing loss in children Material & Methods: The study was carried out at a tertiary care centre in the Dept of Orthodontics & Dentofacial Orthopedics in collaboration with the Dept of ENT and Dept of Physiology after due clearance from the institutional committee. A sample of 30 children between age of 8 to 15 years seeking orthodontic treatment, treated with RME and evaluated for improvement in SDB, conductive hearing loss and decrease in AHI parameters using pre and post lateral cephalograms, PA cephalograms and Acoustic Pharyngometry. Data acquired was statistically evaluated and presented along a median with p-value at 0.05 and the hypotheses were formulated using two tailed alternatives against each null hypothesis. Results: Wilcoxon's signed rank test, showed that the distribution of post-treatment maxillary dentoalveolar parameters was significantly higher compared to the pre-treatment maxillary dentoalveolar parameters, post treatment cephalometric nasal and upper airway parameters were significantly higher compared to the pre-treatment, a positive impact on the upper airway especially NAS and VAS was observed, post treatment acoustic pharyngometry parameters (such as Mean volume, Mean area and Minimum area) which were significantly higher compared to the average pre-treatment parameters, AHI was significantly lower compared to the pre-treatment AHI showing marked improvement and conductive hearing loss improved post RME, leading to near normalization. Conclusion: All maxillary dentoalveolar parameters, nasal width and transverse maxillary width improved, Nasopharyngeal and Velopharyngeal airway space showed improvement as the maxillary trnasverse width improved post RME, tongue posture improved to a more downward and forward position significantly. Apnea-Hypopnea Index reduced leading to improvement in sleep parameters and its associated signs and symptoms. Post RME, changes in the maxillary transverse width also improved the anatomical relationship of the associated muscle attachments especially the tensor and levator palatani muscle attachments, thereby improving the conductive hearing loss in the subjects.