AR Maw - Academia.edu (original) (raw)

Papers by AR Maw

Acta oto-rhino-laryngologica Belgica, 1994

Two hundred and twenty two children with bilateral secretory otitis media were allocated at rando... more 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.

Journal of the Royal Society of Medicine, 1985

One hundred and fifty-five children suffering bilateral otitis media with effusion (OME) and obse... more 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.

The Practitioner, Jan 8, 1987

The Journal of Laryngology & Otology, 1972

Clinical Otolaryngology, 1985

In a prospective investigation of the treatment of glue ear in children, the possible role of per... more 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.

Clinical Otolaryngology, 1992

A sample of 201 children aged between 2 and 9 years with bilateral chronic otitis media with effu... more 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&amp;#39;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.

Auris Nasus Larynx, 1985

Adenoidectomy is a recommended treatment for otitis media with effusion (OME). This work updates ... more Adenoidectomy is a recommended treatment for otitis media with effusion (OME). This work updates 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.

International Journal of Pediatric Otorhinolaryngology, 1996

A new method of measuring nasal volume has been developed called 'Manometric Rhinometry'. We desc... more A new method of measuring nasal volume has been developed called 'Manometric Rhinometry'. We describe the principle behind its use and present the results of measuring two groups of normal children aged 4410. The total volume of the nasal cavity, paranasal sinuses and postnasal space in these children averaged 81 ml in 4-year olds and 140 ml in IO-year olds when measured using an open cell foam plug. Where a rigid nasal tip was used the volume averaged 67 ml in 4-year olds rising to 99 ml in 8-year olds. Correlation with age, weight, height and head circumference showed the greatest correlation with height (r = 0.66). Multiple regression analysis did not add further explanatory power.

International Journal of Pediatric Otorhinolaryngology, 1984

Otitis media with effusion (OME) is one of the commonest, chronic otological conditions of early ... more 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 ~ffect 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~< 0.001) and similarly the effect of adenotonsillectomy is significant (P ~< 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.

Journal of Laryngology and Otology, Jul 1, 1990

The Journal of Laryngology & Otology, 1990

Clinical Otolaryngology, 1990

The aetiology of tympanosclerosis following grommet insertion remains controversial. In this stud... more 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.

The Journal of Laryngology & Otology, 1973

British Journal of Surgery, 1968

Advances in oto-rhino-laryngology, 1988

This study demonstrates a significant resolution of effusions which is maintained for at least 3 ... more 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...

Rhinology, 1990

Nasometry is an objective technique that was originally devised for assessing nasality of speech.... more 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.