Using tympanometry to detect glue ear in general practice.
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Acoustic Impedance Tests↗
Biomedical subjects
A R Maw
Publications and source records attributed to A R Maw.
The dangers of minor blunt laryngeal trauma.
Since the introduction of seat belts, laryngotracheal trauma has become a rare injury, comprising less than one per cent of blunt trauma cases seen at major trauma centres. However, a wide range of damage to the soft tissue and cartilaginous framework of the larynx may result from such injuries but signs of injury are easily overlooked leading to potentially serious consequences for the patient. We report a case of isolated blunt laryngeal trauma from a relatively minor injury which illustrates some of the problems resulting in these cases and review the treatment of blunt laryngeal trauma.
Child↗
A conservative approach to the management of otitis media with effusion in cleft palate children.
Otitis media with effusion (OME) is almost universal in children born with a cleft palate. Early placement of a ventilation tube to alleviate hearing problems is common. A retrospective study has been carried out to assess whether the practice of tube placement only for definite clinical indications is successful in terms of subsequent hearing levels and speech and language development. This was assessed by a case note review, analysis of speech therapy data and by means of a special follow-up clinic. There was no difference in speech development between those treated with tube insertion for OME and those untreated. Audiological thresholds were worse in the treated group. A similar number in each group required regular speech therapy. More abnormal otological findings were present at follow up in those who had tubes inserted, some of these were directly attributable to the presence of tubes. A conservative management of OME in cleft palate children, with tube insertion for only definite clinical indications, is an appropriate management, and will lead to fewer otological complications of tube insertion.
Adolescent↗
The effect of parental smoking on outcome after treatment for glue ear in children.
A sample of 201 children aged between 2 and 9 years with bilateral chronic otitis media with effusion (OME) were treated prospectively and at random by adenoidectomy, adenotonsillectomy, or with neither procedure. In all cases only a unilateral grommet was inserted and the contralateral unoperated ear was examined one year post-operatively for persistence or resolution of the effusion. A self-administered questionnaire was completed by the parents concerning their smoking habits. The resolution of effusion following surgery was assessed in relation to smoking by by the mother and father separately and in combination. Clearance of glue was statistically less frequent where the child's mother or where both parents smoked. This was related to the number of cigarettes smoked by the mother or both parents. The adverse effect was demonstrable whether or not adenoidectomy or adenotonsillectomy had been performed for treatment. The findings lend further support or professional and governmental opinions of a deleterious effect of passive smoke exposure on children and in this case parental smoking has been shown to have an adverse effect on the outcome of OME following surgical treatment.
Child↗
Nasal mucociliary clearance and resolution of otitis media with effusion in children following adenoidectomy.
Numerous workers have studied the relationship between nasal mucociliary clearance and adenoid removal in terms of nasal function. This study was performed to investigate the role of preoperative saccharin clearance time and velocity determination in selecting children with established otitis media with effusion (OME) for adenoidectomy. Testing was not found to be particularly reproducible and there was no statistically significant relationship between mucociliary parameters and the otoscopic resolution of effusion.
Adenoidectomy↗
ENT surgery and cystic fibrosis.
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Adult↗
Lateral cephalometric analysis of children with otitis media with effusion: a comparison with age and sex matched controls.
Previous reports from this department have established significant differences in the morphology of the nasopharynx between patients with otitis media with effusion (OME) and normal controls. This study has used lateral cephalometric analysis to investigate these differences in greater detail. Skeletal and soft tissue measurements were recorded in 50 patients with bilateral OME and were compared with 50 age and sex matched normal controls. Various points were plotted enabling 23 different linear dimensions and three angles in and around the nasopharynx to be compared. The results show significant differences between the two groups in the skeletal and soft tissue dimensions of the nasopharynx. The children with OME have a smaller nasopharynx with a suggestion that this may be due to a difference both in the rate and timing of growth.
Aging↗
Development of tympanosclerosis in children with otitis media with effusion and ventilation tubes.
Ventilation tube (VT) insertion is an accepted treatment for chronic otitis media with effusion (OME) in children. One hundred and eighty five children with bilateral OME were treated by unilateral myringotomy and VT insertion with no treatment to the contralateral ear. During a 5 year follow-up 95 of the children required only one VT but the remainer required more than one but always treatment was carried out to the same ear. The rate of development of tympanosclerosis was measured and scored. After 2-3 years the extent of the sclerotic changes stabilised and the rate of development reached 37-39 per cent in ears receiving only one VT, compared with 47-49 per cent in ears treated by more than one tube. The extent of the changes was no different whether or not one or more than one tube had been inserted. There was no overall evidence of resolution of sclerotic change with time.
Child↗
Sudden total deafness in sickle cell disease.
Sickle cell disease is a world-wide problem which has been noted to cause high tone sensorineural hearing loss. We report a case with sudden onset bilateral hearing loss which progressed to total sensorineural deafness. To our knowledge there has been no report of such a case occurring previously.
Adult↗
Secretory otitis media: a review of management by consultant otolaryngologists.
A questionnaire concerning various aspects of secretory otitis media was completed by a random sample of Consultant Otolaryngologists in the United Kingdom. The replies to questions associated with the management of this condition are presented. The results suggest only a moderate degree of agreement between Consultants in many areas of management and these findings are discussed in the light of current research.
Child↗
The use of ventilation tubes in secretory otitis media: a review of consultant otolaryngologists.
A questionnaire concerning various aspects of secretory otitis media was completed by a random sample of Consultant Otolaryngologists in the United Kingdom. The replies to questions associated with the use of ventilation tubes are presented. The results suggest a wide disparity associated with their use and these findings are discussed with reference to current research.
Child↗
A long term view of myringoplasty in children.
Fifty-nine type 1 tympanoplasties in children under 14 years of age were assessed by recall to a special follow-up clinic up to 15 years post-operatively. Overall 78 per cent of tympanic membranes were found to be intact with a late failure of grafts noted in 6 per cent of cases. An improvement in the audiological threshold was found in 51 per cent, 24 per cent were unchanged, the remaining 25 per cent suffered a deterioration which was seen both immediately post-operatively and thereafter until reviewed in the special clinic. The age at operation, size of the perforation, grade of surgeon carrying out the operation and prior adenoidectomy had no statistically significant influence on the success rate or the audiological outcome. Revision procedures achieved similar graft take rates to the initial procedures but fared worse audiologically. We conclude that in the majority the operation was successful but hearing gain was not as good as expected and subject to late deterioration. A long term follow-up is important to detect this and other complications.
Adolescent↗
Auro-nasopharyngeal polyp and cholesteatoma.
We report the association of an auronasopharyngeal polyp arising in a congenitally abnormal middle ear and Eustachian tube. Subsequently, ten years after removal of the polyp and insertion of a ventilation tube, there was recurrence of the polyp in association with cholesteatoma of the middle ear.
Adult↗
Papillary adenocarcinoma of the middle ear.
A case of papillary adenocarcinoma of the middle ear is presented. The patient had an unusually short history of otalgia, aural discharge and facial palsy, and, at presentation the tumour was too large for surgical resection to be a feasible option. The management of this rare tumour is discussed and the relevant literature reviewed.
Adenocarcinoma, Papillary↗
Intra-tympanic membrane bleeding after grommet insertion and tympanosclerosis.
The aetiology of tympanosclerosis following grommet insertion remains controversial. In this study tympanosclerotic changes of the tympanic membrane in 92 ears were shown to be related to the presence of intra-epithelial haemorrhage shortly after myringotomy with grommet insertion (P less than 0.01) and to the grommet being in situ on follow-up 6 months later (P less than 0.025). Ears in which haemorrhage was absent and where the grommet had extruded did not develop tympanosclerosis. These findings would indicate that bleeding, if causally implicated is not the sole aetiological factor, but careful attention to surgical technique to reduce this may subsequently minimize the development of tympanosclerotic changes.
Child↗
A comparison of active anterior rhinomanometry and nasometry in the objective assessment of nasal obstruction.
Nasometry is an objective technique that was originally devised for assessing nasality of speech. It is based on a comparison of the acoustic output from the nose and the mouth for a given spoken word or phrase. Subjects with nasal obstruction tend to have "hyponasal" speech and this study compares the standard technique of active anterior rhinomanometry with nasometry in the objective assessment of nasal obstruction. There was a significant association between the Total Nasal Resistance (TNR) and the nasality measurements using nasophonemically enhanced test phrases in 15 adult subjects. This test has obvious advantages over rhinomanometry which can be difficult, time consuming and unreliable particularly in the younger and severely congested patient.
Adult↗
Rhinomanometry in the selection for adenoidectomy and its relation to preoperative radiology.
Recent work has shown that resolution of otitis media with effusion (OME) following adenoidectomy may be related to certain preoperative radiographic parameters. This study was performed to investigate the relationship between the total nasal resistance (TNR), adenoid volume and the radiographic palatal airway and adenoid depth in children with OME. Fifty-six children underwent anterior active rhinomanometry and 40 completed the investigation. There was a significant association between the Palatal Airway and the TNR, and in the 27 who subsequently underwent adenoidectomy this was nearly so with respect to adenoid volume and TNR. The relationship demonstrated was not strong enough for TNR to be of use in selection of children for adenoidectomy based on radiographic parameters. Rhinomanometry can be difficult and time-consuming to perform in children. In its present form it is unlikely to be of routine clinical use in this context.
Adenoidectomy↗
Treatment of glue ear in relation to radiographic palatal airway size: a predictor for outcome following adenoidectomy?
Adenoidectomy performed for 'glue ear' accounts for many of the admissions for surgery in childhood. In spite of this there are no objective guidelines to enable the clinician to select those cases in whom a definite benefit is likely, or in whom such procedures might best be avoided. A total of 147 children with established bilateral glue ear randomized to adenoidectomy (A) or no pharyngeal surgery (NS) treatment groups were examined for clearance of effusion in an unoperated ear after one year. Outcome was analysed with respect to the pre-operative Radiographic Palatal Airway size in three groups in relation to mean measurements obtained from matched populations of normal children and those with established disease. Those with small airways had significantly increased clearance following A when compared with NS between the ages of 3-7 years. Adenoidectomy should probably not be performed in those children with large airway measurements, although the outcome may ultimately be related to the age at which surgery is performed.
Adenoidectomy↗