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Biomedical subjects

A P Freeland

Publications and source records attributed to A P Freeland.

At least 19 recordsLinked to original sources
PubMed1997

The predictive value of tympanometry in the diagnosis of middle ear effusion.

Over a 12-month period 501 children (age range 11 months to 15 years) underwent surgery for a possible middle ear effusion. All had tympanometry performed within 2 h of surgery. The results of tympanometry were correlated with the surgical findings in 955 ears. A type-B tympanogram has a high sensitivity (0.91) in predicting middle ear effusion with good specificity (0.79). A type-A tympanogram has a very high specificity (0.99) in predicting a dry middle ear but low sensitivity (0.34). Both the positive (0.91) and negative (0.84) predictive values of a type-A tympanogram are high. The addition of a type-C tympanogram increases the sensitivity of predicting a dry middle ear to 0.79. The positive predictive value of a peaked (type-A or -C) tympanogram is 0.71 and should be considered strong evidence that the middle ear is dry. Tympanometry is the best clinical test for the presence or absence of a middle ear effusion, and on the basis of preoperative tympanometry alone the need for surgery should be carefully reassessed.

Acoustic Impedance Tests↗
PubMed1997

Grommets and patient satisfaction: an audit.

With the increasing role of evidence-based medicine we, as ENT surgeons, are being asked more and more to justify the practice of grommet insertion in children with glue ear. The audiological improvement which follows this operation is often only moderate at best. When judged solely in terms of hearing improvement, one may miss the often dramatic all-round improvement in a child which the parents frequently report to us postoperatively. We set out to confirm this clinical observation by using a retrospective questionnaire, seeking parental opinion after their children had undergone grommet insertion. We found a wide range of reported benefits as a result of grommet insertion; these include an improvement in hearing (92.1%), a reduced frequency of ear infections (74.1%), a reduction in postoperative GP visits (87%), less time missed from school (70.7%), as well as a variety of improvements in children's speech, education and general behaviour. Overall, we found that 96.7% of parents were satisfied that the decision to insert grommets in their child was correct. We feel that these non-audiological factors should be taken into account when judging the potential benefit to a child, or population of children, from grommet insertion.

Absenteeism↗
PubMed1995

Chondromyxoid fibroma of the nasal bone with extension into the frontal and ethmoidal sinuses.

Chondromyxoid fibroma is a rare benign tumour whose histological appearance may easily be misinterpreted as chondrosarcoma. It has a tendency to recur locally unless completely excised. A rare case of the tumour affecting the nasal bone with extension into the frontal and ethmoidal sinuses and impingement on the cribiform plate is presented. Complete excision was achieved by the craniofacial resection approach.

Chondroblastoma↗
PubMed1995

Short- and long-term outcomes of uvulopalatopharyngoplasty for snoring.

Uvulopalatopharyngoplasty is a well established and highly successful operation in the treatment of snoring. However, most published data are based on relatively short-term follow-up results. Anecdotal cases of late recurrence of snoring after an initially successful surgical result have been reported but few formal studies have been performed to determine the true magnitude of this problem. We compared the short-term and long-term results on our patients and found the late recurrence rate after a minimum follow-up period of 12 months (range: 12-84 months, mean 31.3 months) to be in the region of 13%. The risk of recurrence was directly related to the body mass index.

Adult↗
PubMed1992

The effect of anaesthesia on tympanograms of children undergoing grommet insertion.

A prospective study was designed to assess the effect of anaesthesia, including nitrous oxide, on tympanometric results of children undergoing myringotomy and possible grommet insertion. 155 patients (310 ears) were examined with a pneumatic otoscope and had tympanograms performed within 1 hour of operation. The patients were then anaesthetized by a combination of intravenous and gaseous anaesthetic. Immediately before myringotomy, a tympanogram was repeated. In 13% of patients predicted to have fluid at admission, there was a change in their tympanogram after induction of anaesthesia, suggesting clearance of fluid. At myringotomy, these ears were dry. We surmise that there was displacement of fluid from the middle ear by nitrous oxide during the early stages of anaesthesia. Thus we feel that, if an otologist confidently expects to find an effusion at myringotomy, the presence of a dry tap should not change his management plan.

Acoustic Impedance Tests↗
PubMed1991

Orf of the pinna.

A case of orf affecting the pinna is discussed. This is an unusual presentation of an infection that is common in farming communities. At the initial presentation the diagnosis was not suspected, the management therefore was inappropriate and probably gave rise to the secondary infection that ensued. The history described is classical. Orf affecting the external auditory canal has been reported once, but orf affecting the pinna has not been described before.

Adult↗
PubMed1991

Styloid apparatus anomaly causing dysphagia.

An unusual case of dysphagia due to anomalous styloid apparatus anatomy is presented. Clinical and radiological findings are documented. Variations in anatomy and clinical syndromes are discussed together with management.

Cervical Vertebrae↗
PubMed1991

Workload trends in otolaryngology: some statistical observations from medical record linkage.

Trends in admission rates, lengths of stay, and clinical case mix (adjusted for multiple admissions per person) for Otolaryngology from 1975 to 1985 are described using the Oxford Record Linkage Study. Person-based admission rates increased generally, most strikingly amongst children and adolescents. Both length of stay per episode and total number of days an individual stayed in hospital each year decreased. Operations on tonsils and adenoids decreased averaging 2.2% per annum; admissions for diagnoses for otitis media with effusion increased averaging 8.2% per annum; for the operations of myringotomy and tympanostomy tube insertion increased averaging 9.2% per annum; for other diagnoses related to the ear increased averaging 5.7% per annum; and admissions for malignant neoplasms decreased averaging 2.0% per annum. Clearly more people are being treated for a changing case mix. The largest increases are occurring with children and adolescents.

Adolescent↗
PubMed1991

Audit of stapedectomy results in a teaching hospital.

The number of stapedectomies performed annually has declined since 1963. Also, surgery has become available at an increasing number of centres, resulting in a further fall in the number of such operations performed in teaching hospitals. Several studies have suggested benefit might be gained, both by patients and by otology as a speciality, from limiting training to post-graduates who show an aptitude for otology, and concentrating surgery in a small number of specialized centres. We report a series of 179 patients who had stapedectomy performed for otosclerosis in a teaching hospital. We have retrospectively compared the audiological outcome and complication rates for consultants and surgical trainees. For the two groups, there is no significant difference in postoperative hearing levels and complication rates are similar. Our success rate is comparable to other major series. We conclude that stapedectomy is a safe procedure to teach adequately experienced and supervised trainees.

Adult↗
PubMed1990

A randomised controlled trial of surgery for glue ear.

OBJECTIVE: To assess the effect of five different surgical treatments for glue ear (secretory otitis media) on improvement in hearing and, assuming one or more treatments to be effective, to identify the appropriate indications for surgery. DESIGN: Randomised controlled trial of children receiving (a) adenoidectomy, bilateral myringotomy, and insertion of a unilateral grommet; (b) adenoidectomy, unilateral myringotomy, and insertion of a unilateral grommet; (c) bilateral myringotomy and insertion of a unilateral grommet; and (d) unilateral myringotomy and insertion of a grommet. Children were followed up at seven weeks, six months, 12 months, and 24 months by symptom history and clinical investigations. SETTING: Otolaryngology department in an urban hospital. PATIENTS: 149 Children aged 4-9 years who were admitted for surgery for glue ear and who had no history of previous operations on tonsils, adenoids, or ears and no evidence of sensorineural deafness. Inadequate follow up information on levels of hearing and on middle ear function was obtained from 22. MAIN OUTCOME MEASURES: Mean hearing loss (dB) of the three worst heard frequencies between 250 and 4000 Hz, results of impedance tympanometry, and parental views on their child's progress. RESULTS: In the 127 children for whom adequate information was available ears in which a grommet had been inserted performed better in the short term (for at least six months) than those in which no grommet had been inserted, irrespective of any accompanying procedure. Most of the benefit had disappeared by 12 months. Adenoidectomy produced a slight improvement that was not significant, though was sustained for at least two years. The ears of children who had had an adenoidectomy with myringotomy and grommet insertion, however, continued to improve so that two years after surgery about 50% had abnormal tympanometry compared with 83% of those who had had only myringotomy and grommet insertion, and 93% of the group that had had no treatment. Logistic regression analyses identified preoperative hearing level as the single best predictor of good outcome from surgery. Other variables contributed little additional predictive power. CONCLUSIONS: If the principal objective of surgery for glue ear is to restore hearing then our study shows that insertion of grommets is the treatment of choice. The addition of an adenoidectomy will increase the likelihood of restoration of normal function of the middle ear but will not improve hearing. When deciding appropriate indications for surgery, a balance has to be made between performing unnecessary operations and failing to treat patients who might benefit from surgical intervention. Preoperative audiometry scores might be the best predictor in helping to make this decision.

Acoustic Impedance Tests↗
PubMed1987

The surgical treatment of a pharyngeal pouch: inversion or excision?

Twenty eight patients with pharyngeal pouches were treated at the Radcliffe Infirmary, Oxford, between 1975 and 1985. Nineteen of these patients had the pouch excised and 9 patients had the pouch inverted. Preoperative and postoperative cine barium swallows were obtained on all patients. The results show pouch inversion to be an effective method of treatment with a low recurrence rate, and fewer complications compared with pouch excision. Inversion of a pharyngeal pouch with a cricopharyngeal myotomy is therefore recommended as a safe, satisfactory treatment.

Adult↗
PubMed1987

The consequences of delay in tonsil surgery.

A prospective study was designed to determine whether there is any morbidity caused by the delay of tonsil surgery while patients are on long waiting lists in the United Kingdom. It was found that, far from being harmful, a long waiting list allows one in five children to "grow out" of their problems, saving 20 per cent of patients from unnecessary surgery.

Absenteeism↗
PubMed1986

The long-term results of hyoid-sternohyoid grafts in the correction of subglottic stenosis.

The long-term follow-up of eight patients with established subglottic stenosis managed with a composite hyoid-sternohyoid graft is reported. Four of these patients were children. All but one of the patients were extubated within four months of surgery. The reconstructed airway is shown to grow with age and re-stenosis has not occurred. Apart from post-operative granulation tissue at the repair site, the major complication has been a breathy voice in two children due to overwidening of the larynx.

Adult↗
PubMed1986

Prolonged positive airway pressure for severe neonatal tracheobronchomalacia.

A very low birthweight preterm baby with respiratory distress at birth was found to have severe congenital tracheobronchomalacia. Continuous positive airway pressure was given through an endotracheal tube without tracheostomy for 15 weeks before unassisted respiration could be maintained. Diagnosis was made and progress monitored by laryngobronchoscopy on three occasions.

Bronchial Diseases↗