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Biomedical subjects

A R Maw

Publications and source records attributed to A R Maw.

At least 37 records · Page 2Linked to original sources
PubMed1994

Factors affecting resolution of otitis media with effusion in children.

There is only limited knowledge of the factors which influence the outcome of otitis media with effusion in children in the long-term. This randomized controlled study assessed the therapeutic effect of adenoidectomy and adenotonsillectomy during a 5-year follow-up. Numerous pre-treatment independent variables concerning the child's upper and lower respiratory tract, atopic status and parental habits were assessed in relation to two dependent outcome measures. These were otoscopic clearance of effusion and no peak/peak tympanometric change. A total of 222 children was studied and reviewed annually for 5 years. Four of 43 independent variables were found to be repeatedly significant in relation to outcome: (a) whether or not adenoidectomy was performed; (b) age at operation; (c) history of earache prior to operation; and (d) parental smoking habits. The results provide further evidence of a beneficial effect of adenoid removal and the importance of the age at which surgery is advised. They also suggest the need to investigate further the relationship of superadded acute suppurative otitis media with otalgia and the outcome of chronic otitis media with effusion. Finally, avoidance of parental smoking will have a beneficial effect on children's middle ear disease.

Adenoidectomy↗
PubMed1994

Does adenoidectomy have an adjuvant effect on ventilation tube insertion and thus reduce the need for re-treatment?

Two hundred and twenty-two children with bilateral otitis media with effusion were followed for 5 years. A ventilation tube was inserted into one ear only and reinserted if the condition had not resolved. The need for reinsertion in 139 children in whom the adenoids were also removed was compared with the 83 children treated by tube insertion alone. In the combined group in year 1, 91% required one tube compared with 62% treated with only a tube. By year 5, 66% of the combined group required one tube compared with 32.5% in those without adenoidectomy. There was some relationship between tube reinsertion and age, and also with parental smoking. It is possible that the combination of adenoidectomy with tube insertion may prove more cost-effective than tube insertion in selected cases alone. In addition, once adenoidectomy becomes more established as a day case procedure, the cost benefit will be more advantageous in those children treated with adenoidectomy and a tube compared with those treated with only a tube.

Adenoidectomy↗
PubMed1994

Tympanometry, stapedius reflex and hearing impairment in children with otitis media with effusion.

The study assessed the relationship between tympanometry, stapedius reflex and pure tone audiometric hearing impairment. A total of 581 audiograms and typanograms from 370 children aged between 3 and 10 years were studied. Only one ear was examined. Measurements of the pure tone air conduction thresholds (PTACT) were made: firstly as an average of the thresholds from 500, 1,000, and 2,000 Hz, secondly as an average of six frequencies from 250 Hz to 8 Hz. The mean PTACT were calculated for each year of age and for each type of tympanogram. Tympanograms were further subdivided by the presence or absence of the stapedius reflex. The sensitivity, specificity and predictive value of a type B tympanogram were investigated for different ages in relation to mean six frequency PTACT at 20, 25 and 30 dB HL. The results were used to show the accuracy of a type B tympanogram in detecting hearing impairment in children of different ages. The results suggest that tympanometry may be used to screen younger children with otitis media with effusion for hearing impairment, without the need for a pure tone audiogram.

Acoustic Impedance Tests↗
PubMed1994

The long term outcome of secretory otitis media in children and the effects of surgical treatment: a ten year study.

Two hundred and twenty two children with bilateral secretory otitis media were allocated at random for adenoidectomy, adenotonsillectomy or for neither procedure. In all cases only a unilateral grommet was inserted. The contralateral unoperated ear was examined during a ten year period to show otoscopic clearance, change in tympanometric status and improvement in mean hearing threshold. Adenoidectomy or insertion of a grommet alone produces similar improvement but in combination are more effective than either procedure in isolation. The unoperated ear in cases not receiving either procedure reflects the natural history of the condition. It shows a steady improvement in all outcome measures as time passes.

Acoustic Impedance Tests↗
PubMed1993

Tympanic membrane ossification.

Ossification of the tympanic membrane after myringoplasty is recorded for the first time. Myringoplasty was performed for closure of a perforation which followed the surgical treatment of otitis media with effusion and had included the insertion of a long-term T-tube.

Audiometry, Pure-Tone↗
PubMed1993

Does the type of middle ear aspirate have any prognostic significance in otitis media with effusion in children?

Two hundred and twenty-two children with chronic, bilateral middle ear effusions were assessed during a 2 year follow-up period. At initial myringotomy the middle ear aspirate was found to be serous in 44 children and mucoid in 178 children. Evaluation at 1 and 2 years post-operatively showed no difference in otoscopic fluid clearance or mean hearing threshold at either follow-up time in relation to either type of fluid. There was no greater need for ventilation tube reinsertion in either group during the overall follow-up period. There was found to be no significant difference between the children with serous or mucoid effusions in relation to a range of pre-operative and operative variables. The study suggests that outcome in terms of fluid clearance and hearing thresholds is independent of the fluid type and there appears no greater need for revision ventilation tube insertion in relation to the findings at myringotomy. The type of effusion found on aspiration prior to ventilation tube insertion has no prognostic value. Children with serous fluid should be managed in an identical manner to those in which the fluid is thicker and mucoid in character.

Audiometry, Pure-Tone↗
PubMed1993

A model to refine the selection of children with otitis media with effusion for adenoidectomy.

The selection of children with otitis media with effusion for adenoidectomy has been criticized on a number of grounds. In spite of the widespread popularity of the procedure there are few objective guidelines to help the otolaryngologist make a decision which is therefore usually subjective. We present a scientifically derived model using a Generalized Linear Interactive Modelling (GLIM) technique from a population of 122 children who underwent either adenoidectomy or no pharyngeal surgery. The outcome parameter studied was otoscopic clearance in an unoperated ear 1 year after treatment. This was related principally to the operation type (P < 0.001) and to the age at which the operation was performed (P < 0.005). Using a probability of clearance threshold of 50% the model was tested on a prospective population of 166 children and outcome was correctly predicted in over 72%. This model enables the surgeon to determine the probability of clearance of effusion following adenoidectomy in an individual child. At a probability threshold of 50% adenoidectomy would be offered to children with bilateral otitis media with effusion aged between 4.33 and 8.00 years. Over the age of 8 years the probability of clearance occurring spontaneously increases beyond 50%. By careful selection of the probability of clearance thresholds it was possible to produce otoscopic resolution in over 80% of those selected to undergo adenoidectomy. The model also enables the otolaryngologist to determine the proportion of children with established disease that require adenoidectomy at his own chosen probability thresholds which will ensure that a more effective resource allocation is achieved.

Adenoidectomy↗
PubMed1993

Conservative treatment of otitis media with effusion by autoinflation of the middle ear.

A total of 85 children on the waiting list for grommet insertion aged between 3 and 10 years with bilateral chronic otitis media with effusion (OME) were assigned at random to an observation or treatment group. Those in the treatment group were given the Otovent device to use three times a day for the duration of the study and both groups were then seen at monthly intervals for 3 months for pneumatic otoscopy and tympanometry. Statistically significant improvement was seen in those using the treatment with a compliance of more than 70%. This was detected on the outcome measures of tympanometry and pneumatic otoscopy after 1, 2 and 3 months. No side effects were demonstrated. We conclude that autoinflation is an effective short-term treatment for children with OME when used regularly under supervision.

Age Factors↗
PubMed1993

Assessment of sequelae at home following adenotonsillectomy. A basis for day-case management?

Adenotonsillectomy is traditionally performed as an in-patient procedure. Although day-case adenotonsillectomy is practised in some units in the USA, Canada, Finland and Israel, it is rarely practised in the UK. This study looks at a cohort of 100 consecutive children admitted for adenotonsillectomy and follows their progress after discharge. It also assesses parental attitudes to day-case surgery. The results highlight parental anxiety associated with day-case adenotonsillectomy. Only 28% of parents would have liked the procedure to be carried out on a day-case basis with 46% of parents considering a single night stay to be too short. More support must be given to parents in the UK if day-case adenotonsillectomy is to become an acceptable procedure.

Adenoidectomy↗
PubMed1992

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↗
PubMed1992

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↗
PubMed1992

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↗
PubMed1992

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↗
PubMed1991

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↗
PubMed1991

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↗
PubMed1991

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↗