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Biomedical subjects

A R Maw

Publications and source records attributed to A R Maw.

At least 55 records · Page 3Linked to original sources
PubMed1991

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↗
PubMed1990

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↗
PubMed1990

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↗
PubMed1990

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↗
PubMed1990

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↗
PubMed1990

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↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

Transmastoid extracranial repair of CSF leaks following acoustic neuroma resection.

Acoustic neuromas may be resected either by a suboccipital craniectomy or translabyrinthine approach; the latter gives good access without unduly traumatising the brainstem, but can lead to a higher incidence of cerebrospinal fluid (CSF) leaks. The surgical management of these leaks can be difficult; we describe a transmastoid extracranial technique using pedicled sternomastoid muscle that has produced complete resolution of the leak in all cases managed in this way.

Adult↗
PubMed1989

No peak-peak tympanometric conversion following surgery for otitis media with effusion in relation to airway size: a new treatment strategy?

This study was performed to examine the relationship between the pre-operative radiographic palatal airway and no peak-peak tympanometric conversion 1 yr following adenoidectomy, adenotonsillectomy or no pharyngeal surgery performed for otitis media with effusion. A relationship between the airway in children with otitis media with effusion and matched controls is described and this is used to analyse tympanometric change in 3 airway size groups. No peak-peak conversion was significantly greater following adenoidectomy or adenotonsillectomy compared with no pharyngeal surgery in those with small airways and tonsillectomy conferred no additional benefit. Adenoidectomy with or without tonsillectomy is probably best avoided in children with large radiographic palatal airway measurements when planning surgical treatment for established disease, although this may ultimately be related to age at operation.

Acoustic Impedance Tests↗
PubMed1989

An objective method of assessing nasality: a possible aid in the selection of patients for adenoidectomy.

We present an appraisal of an objective technique for assessing nasality, or the nasal component of speech. Evidence suggests that a subjective impression of hyponasal speech is related to the adenoid volume and the radiographic palatal airway, although clinical assessments may have poor inter- and intra-observer agreement. Determination of the oral and nasal acoustic ratio or 'Nasalance' is quick, painless, and non-invasive. There was good agreement and reproducibility within normal subjects when test phrases were used. Words such as 'bananas' which contain nasal consonants showed large reductions in the Nasalance score when the nostrils were occluded and are of use in clinical assessment. This method may be of use in refining the selection of children for adenoidectomy.

Adenoidectomy↗
PubMed1989

The skull base and nasopharynx in Down's syndrome in relation to hearing impairment.

Children with Down's syndrome have a higher incidence of middle ear effusion than normal children. Twenty-eight patients with Down's syndrome and 33 age and sex-matched normal controls were studied. They were subdivided into 2 further matched groups on the basis of having normal or impaired hearing. Each underwent pneumatic otoscopy, audiometry and lateral head and neck radiography. This study examines radiological parameters to determine whether skeletal or soft tissue factors within the skull base or nasopharynx could be implicated as a cause or diagnostic feature of Eustachian tube dysfunction. The nasopharynx tended to be smaller in those with Down's syndrome and this resulted in a reduction in the airway size due to encroachment by the soft tissues. The angle between the base of skull and hard palate was significantly less acute in those with Down's syndrome and in those with hearing loss.

Child↗
PubMed1989

Aural polyps as predictors of underlying cholesteatoma.

In a retrospective study of 96 patients 16 different histological features were examined in 100 aural polyps to see whether some or any could be used to predict the presence or absence of a cholesteatoma underlying the polyp. The patients were divided into those who had cholesteatoma and those who did not, so that discriminatory features were identified. These were combined to make an overall prediction of the probability of a cholesteatoma in the middle ear. The results showed that any polyp that (i) was composed of raw granulation tissue and (ii) contained keratin as flakes or masses had a 70-80% probability of being associated with an underlying cholesteatoma. In contrast, when a polyp (i) was composed of a fibrous core, (ii) had a covering epithelium, and (iii) contained glands and lymphoid aggregates, there was a 70-80% probability of cholesteatoma being absent. This scoring system can be used to help surgeons decide whether surgical exploration of the mastoid should be undertaken.

Adolescent↗
PubMed1988

Children with glue ear: how do they present?

A prospective study examined 280 children aged between 2 and 11 years with mild or severe forms of otitis media with effusion (OME). There was a 2-year delay between the first suspicion of hearing loss and presentation to an otolaryngologist. In approximately 50% of these children hearing loss was first suspected by the mother and in 20-30% detection was by routine screening tests. In most cases actual hearing loss was the subjective presenting feature, but in others, speech, language or learning difficulties heralded the problem. It is suggested that such data might be incorporated into a questionnaire for parents which may then be used to assess parental ability to detect hearing loss due to otitis media with effusion in small children.

Child↗
PubMed1988

Surgery of the tonsils and adenoids in relation to secretory otitis media in children.

One hundred and fifty children aged between 2 and 9 years with bilateral SOM were allocated at random to three groups: Adeno-tonsillectomy (47 cases), adenoidectomy (47 cases) and neither procedure (53 cases). A further 42 children were allocated to either adenoidectomy or no surgery. In all only one ear was treated at random by myringotomy and insertion of a ventilation tube. The unoperated ear was examined six weeks, six months, nine months, one, two and three years post-operatively for otoscopic clearance of the effusion, impedance change and improvement in mean hearing threshold. Thus the effects on middle ear status of adenoidectomy alone and in combination with tonsillectomy were assessed. There was a significant clearance of middle ear fluid, change from no peak to peak impedance measurement and hearing gain as a result of both procedures with a late trend favouring the combined operation. Neither pre-operative tonsils size nor the number of attacks of tonsillitis affect outcome. However there is a relationship between age and radiographic post-nasal space airway size with clearance of the effusion one year after surgery. These findings permit recommendation for adenoidectomy with improved expectation for resolution of SOM if cases are selected with reference to these two variables. They also suggest in which cases the operation should not be recommended. Despite the trends in outcome favouring combined operations, the extra morbidity associated with the addition of tonsillectomy does not at present justify recommendation for removal of the tonsils in addition to adenoidectomy for cases with SOM. Tonsillectomy in these children should be assessed on grounds of tonsillar pathology per se and not on the status of the middle ear.

Acoustic Impedance Tests↗
PubMed1988

Tonsils and adenoids. Their relation to secretory otitis media.

This study demonstrates a significant resolution of effusions which is maintained for at least 3 years. Improvement results both from adenoidectomy alone and in combination with tonsillectomy. Significant audiometric hearing gain also occurs. There is a slight but statistically insignificant trend in favour of the combined operation, compared with adenoidectomy alone. Similar improvements can be achieved by use of a ventilation tube. But re-insertion is required twice as frequently with a tube alone than in cases where it is combined with adenoidectomy or adeno-tonsillectomy. The relative rates for mortality and morbidity of ventilation tube alone, adenoidectomy or adeno-tonsillectomy are well recognised. Taking these into account and considering the findings of this study there would seem to be little additional benefit from combination of tonsillectomy with adenoidectomy compared with adenoidectomy alone. The necessity for a second or subsequent anaesthetic in cases treated with a tube alone must also be considered. These results give some support to the suggestion that the treatment of choice for established bilateral SOM may be adenoidectomy in selected cases, combined with unilateral insertion of a ventilation tube. The latter procedure effects immediate but short-lived hearing gain. Unilateral compared with bilateral insertion reduces the overall complication rate due to the tube by 50%. The former procedure effects sustained improvement which persists following extrusion of the tube. Further prospective studies are required to predict more precisely those cases in which adenoidectomy should be recommended.

Adenoidectomy↗