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Biomedical subjects

A R Maw

Publications and source records attributed to A R Maw.

At least 73 records · Page 4Linked to original sources
PubMed1987

Tuning fork tests in children (an evaluation of their usefulness).

Despite the huge advances in clinical audiology over the past few decades, tuning fork tests are still used extensively in the diagnosis of hearing loss. This study investigates the usefulness, reliability and accuracy of tuning fork tests in a group of children involved in a prospective study of glue ear, and shows them to be of dubious value.

Child↗
PubMed1987

The nasopharynx and adenoid in children with glue ear compared with normal controls.

This study was designed to demonstrate whether any differences could be detected in the nasopharyngeal soft tissue size and postnasal space airway in children with glue ear compared with controls. Lateral cephalometric radiographs of 34 children with bilateral glue ear confirmed by paracentesis were compared with those of normal children matched for age and sex. There was no difference in the measurement of adenoid depth between the 2 groups. However, it was found that the palatal airway size was significantly smaller in children with bilateral glue ear than in normal children. Reduction in the palatal airway to 4 mm or less is found in most cases with bilateral glue ear, but only in 15% of normal controls.

Adenoids↗
PubMed1986

Otoscopic, impedance, and audiometric findings in glue ear treated by adenoidectomy and tonsillectomy. A prospective randomised study.

150 children aged between 2 and 9 years (mean 5.25 years) with chronic bilateral otitis media with effusion were randomly allocated to three groups who, in addition to unilateral myringotomy and grommet insertion, would have an adenotonsillectomy, an adenoidectomy, or neither. The contralateral ear was assessed. Otoscopic, impedance, and audiometric findings were recorded preoperatively and at six and twelve months postoperatively. Subtraction of the no-surgery results indicates that at twelve months adenoidectomy produces otoscopic resolution of OME in 41.7% and no-peak/peak conversion of impedance in 29.8%. The hearing gain from adenoidectomy alone was similar to that resulting from insertion of a grommet alone, but the children having adenoidectomy required fewer reinsertions to maintain adequate subjective hearing thresholds in the treated ear (26% versus 54%). Tonsillectomy conferred no additional benefit. Without treatment there was a small but significant improvement in all indices at twelve months but not at six months postoperatively.

Acoustic Impedance Tests↗
PubMed1985

The long term effect of adenoidectomy on established otitis media with effusion in children.

Adenoidectomy is a recommended treatment for otitis media with effusion (OME). This work up-dates a previous report and includes a larger number of 155 cases. Surgery has been allocated at random with a control non-adenoidectomy group. The study is prospective and allows for a wide variety of variables. These include age, sex, adenoid size, seasonal variation, observer accuracy, and spontaneous resolution. Adenoidectomy results in clearance of OME even one year following operation in 31-45% of cases. Clearance is related to the duration of history of hearing loss though this may reflect on age effect. Tonsillectomy provides no additional benefit.

Adenoidectomy↗
PubMed1985

Are the tonsils and adenoids a reservoir of infection in otitis media with effusion (glue ear)?

In a prospective investigation of the treatment of glue ear in children, the possible role of persistent infection in the tonsils and adenoids was assessed by comparing bacterial cultures of swabs and resected tissue from the tonsils and adenoids of patients with cultures of swabs from similar sites in control subjects without ENT abnormality. For almost all potential pathogens, including Streptococcus pneumoniae and Haemophilus influenzae, no statistically significant differences were demonstrated between patients and controls. The same was true of Streptococcus pyogenes in tonsil specimens, while in adenoid specimens rather more isolates were obtained in patients than controls. This difference was just statistically significant at the 5% level, but only when all isolations, including very scanty growths, were compared. On present evidence, persistent infection should not be invoked to explain the success of adenoidectomy in otitis media with effusion or to justify adenotonsillectomy.

Adenoids↗
PubMed1985

Factors affecting adenoidectomy for otitis media with effusion (glue ear).

One hundred and fifty-five children suffering bilateral otitis media with effusion (OME) and observed for three months have been followed postoperatively for twelve months. Surgery was randomly allocated into three groups: adenotonsillectomy; adenoidectomy; and no surgery. In all cases unilateral myringotomy and grommet insertion was performed. The contralateral unoperated ear was assessed subsequently for clearance of the effusion. Adenoidectomy produced resolution of the effusion in 31-45% of cases at one year, but tonsillectomy conferred no additional benefit. There was improved resolution in those with longer compared with shorter histories, and in older as opposed to younger children. Assessment of preoperative lateral cephalometric radiographs show improved resolution of the effusion following removal of larger, compared with smaller adenoids, but this effect was only demonstrable for three months. The effect of age was longer-lasting for up to one year postoperatively.

Adenoidectomy↗
PubMed1984

Prospective study of tympanosclerosis developing after grommet insertion.

Grommets have been used as a treatment for middle-ear effusions since their introduction by Armstrong in 1954. However, it is now accepted that the presence of a grommet in a tympanic membrane is associated with the development of tympanosclerosis in that membrane. Furthermore, it has been shown that this is a progressive phenomenon and that the incidence increases with time to as much as 65 per cent at 3 to 4 years after grommet insertion (Mawson and Fagan, 1972; Tos and Poulsen, 1976). Initially it was suggested that the development of tympanosclerosis might be due to the middle ear disease rather than to the grommet (McKinnon, 1971). However, most recent studies have found that, in bilateral cases of effusion, tympanosclerosis develops more frequently in ears with a grommet than in those without (Brown, Richards and Ambegaokar, 1978; Lildholt, 1979). This prospective study was designed to show the development of tympanosclerosis in the tympanic membrane of children treated for bilateral middle-ear effusions and to elicit any factors from the clinical history and operative technique which might be associated with the pathogenesis of the complication.

Child↗
PubMed1983

Chronic otitis media with effusion (glue ear) and adenotonsillectomy: prospective randomised controlled study.

A prospective study was conducted of the effects of adenoidectomy and adenotonsillectomy on established otitis media with effusion unresponsive to medical treatment. The operations were performed at random with a controlled no surgery group on a cohort of 103 children with the condition and the results assessed six weeks, three months, six months, nine months, and one year later. After adenoidectomy the rate of resolution of the condition increased from 39% at six weeks to 72% at one year; and after adenotonsillectomy the rate increased from 59% at six weeks to 62% at one year. In the no surgery group the rate increased from 16% at six weeks to 26% at one year. Compared with the no surgery group the effect of adenoidectomy alone at one year was highly significant (p less than 0.001), and similarly the effect of adenotonsillectomy was significant (p less than 0.01). There was, however, no increased benefit from the addition of tonsillectomy compared with adenoidectomy alone. Thus there was resolution of 36-46% of chronic effusions as a result of adenoidectomy.

Adenoidectomy↗
PubMed1983

Chronic otitis media with effusion and adeno-tonsillectomy--a prospective randomized controlled study.

Otitis media with effusion (OME) is one of the commonest, chronic otological conditions of early childhood. There is considerable variation in management in different centres throughout the world. Surgical treatment of the ears, adenoids, tonsils and sinuses is frequently employed and the condition constitutes one of the main indications for adenoidectomy and to a lesser extent for tonsillectomy. To date no randomized prospective, adequately controlled study has demonstrated the effect of these operations on established OME. The present work reports the results at 6 weeks, 3 months, 6 months, 9 months and one year following adenoidectomy and adenotonsillectomy performed randomly and prospectively with a controlled no-surgery group on a cohort of 103 children with established OME, unresponsive to medical treatment. Following adenoidectomy the rate of resolution of OME increases from 39% at 6 weeks, to 72% at one year; and following adeno-tonsillectomy the rate increases from 59% at 6 weeks to 62% at one year. In the no-surgery group the rate increases from 16% at 6 weeks to 26% at one year. Compared with the no-surgery group the effect of adenoidectomy alone at one year is highly significant (P less than or equal to 0.001) and similarly the effect of adenotonsillectomy is significant (P less than or equal to 0.01). However, there is no increased benefit from the addition of tonsillectomy compared with adenoidectomy alone. Thus adenoidectomy resolves established OME in 36-46% of cases for up to 12 months.

Adenoidectomy↗
PubMed1982

Verrucous carcinoma of the larynx.

Verrucous carcinoma of the larynx is an uncommon but distinct variety of well differentiated squamous carcinoma and accounts for 1-2% of all laryngeal squamous carcinomata. Awareness of the condition both by clinician and histopathologist is essential otherwise the diagnosis may not be made. From a review of the literature and personal assessment of the cases presented here it would appear that local conservative endoscopic treatment with careful follow-up may be the treatment of choice for certain verrucous carcinomata. Such treatment may be either suction diathermy or cryosurgery or laser surgery. Anaplastic transformation has been said to occur following irradiation of these tumours, though this view is not held by all clinicians, some of whom recommend radiotherapy for selected cases.

Aged↗
PubMed1981

How should adenoidal enlargement be measured? A radiological study based on interobserver agreement.

Clinical assessment of adenoidal size is difficult, and an objective measurement is desirable. To establish the best radiological method, lateral cephalometric radiographs were taken of 38 children three days before their adenoids were removed. Two radiologists each made five measurements related to adenoidal size on ech radiograph, and the correlations between the radiological measurements and between the measurements and the volume of tissue removed at operation were calculated. Linear measurement of the palatal airway at the narrowest point between the outlines of the adenoid and soft palate is the simplest method to use and shows good correlation between observers. It is recommended for clinical use. Measurement of the nasopharyngeal soft tissue area show equally good observer correlation and better correlation with the volume of adenoid removed at operation. This method appears more suitable for longitudinal studies of adenoidal size.

Adenoids↗