February 2003

Case submitted by Youn W. Park, MD, and Paul Coleman, MD

		CASE: A 23-year-old woman is experiencing hearing loss from otitis media with effusion. An examination of the oral cavity reveals a cleft of the uvula. She denies any speech problems. WHAT IS YOUR DIAGNOSIS?
		Bifid uvula (split uvula) alone rarely has any clinical significance. Its incidence reportedly is around 1% in the healthy population in the United States, but much higher in native Americans. Some of these patients will be found to have a submucous cleft palate, anatomically the mildest form of cleft palate, which is characterized by a medial notch in the hard palate and failure of the soft palate muscle to join in the midline. Inspection, palpation, and transillumination by placing a light source in the nasal cavity will reveal the defect. Nasopharyngeal procedures such as adenoidectomy in such individuals can create problems in swallowing and talking, including hypernasal speech due to an imperfect palatopharyngeal closure.

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Dr. Park is a clinical professor of otolaryngology at Northeastern Ohio Universities College of Medicine and section head of otolaryngology at Barberton Citizens Hospital in Barberton, Ohio. Dr. Coleman is an attending physician in the department of family practice at Barberton Citizens Hospital.