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Biomedical subjects

B J McWilliams

Publications and source records attributed to B J McWilliams.

At least 19 recordsLinked to original sources

Submucous clefts of the palate: how likely are they to be symptomatic?

A group of 130 patients with submucous clefts were identified from the records of the University of Pittsburgh Cleft Palate-Craniofacial Center. Many of these patients, 44 percent, remained asymptomatic into adulthood, and none required surgical intervention. A submucous cleft should be repaired in infancy only when feeding problems or unremitting ear disease is observed. The cleft should not be repaired on the theoretical basis of the potential effect of the cleft on the development of communication skills. The development of predictors that will enable professionals' valid management decisions must be developed.

Adolescent

The pressure-flow method: some fundamental concepts.

The pressure-flow method introduced by Warren and DuBois is a useful method for estimating velopharyngeal orifice area. However, this investigation shows that unless geometric similarity of subject and model exists, the value of the flow coefficient k used in the equation to estimate velopharyngeal orifice area cannot be established from model tests. Use of k = 0.65 is questioned as that value is typical of thin plate orifices, a geometry that is not a good representation of the velopharyngeal passage. Values of k from the literature and from steady state tests using a model similar to Warren's are presented to show the effect of various inlet shapes. The influence of inlet shape supports the conclusion that k may be significantly higher than 0.65, conceivably approaching values in the range of 0.9 to 0.97, depending on the orifice geometry.

Humans

Weight gain in children with cleft palate from birth to two years.

The weights from birth to 2 years of 77 babies with palatal clefts were compared with the weights of normal babies (Pomerance, 1979). Babies with clefts did not differ from normal infants in mean birth weight, but they lagged behind thereafter. Males were more impaired than females.

Birth Weight

Consequences of unremitting middle-ear disease in early life. Otologic, audiologic, and developmental findings in children with cleft palate.

To learn whether chronic otitis media with effusion during early life has lasting otologic, audiologic, or developmental consequences, we evaluated 24 closely matched pairs of children with repaired palatal clefts whose treatment had been equivalent except with regard to persistent otitis media during early life. One group had undergone early (mean age, 3.0 months) myringotomy with placement of tympanostomy tubes, followed by assiduous monitoring and an aggressive treatment program to maintain ventilation in the middle ear. The other group had undergone initial myringotomy later (mean age, 30.8 months) or not at all (two subjects) and presumably had had continuous middle-ear effusion throughout most or all of the first few years of life. Eardrum scarring was equal in both groups. Hearing acuity and consonant articulation were impaired in both groups, but hearing acuity was less impaired (P = 0.05 to 0.10) and consonant articulation significantly less impaired (P = 0.03) in the group undergoing early myringotomy. Mean verbal, performance, and full-scale IQs and scores on psychosocial indexes were normal in both groups and did not differ significantly between the groups. These findings support the hypothesis that early, longstanding otitis media may result in impairment of hearing and of speech, but they do not support the hypothesis that cognitive, language, and psychosocial development are adversely affected.

Audiometry, Pure-Tone

Life response to Crouzon's disease.

This paper describes the life responses of two adult patients with facial deformities associated with untreated Crouzon's disease. Each patient has normal intelligence, and each has two children and close family relatives who exhibit variable degrees of Crouzon's disease. The impact of untreated facial deformity is considered, and recommendations are made for psychosocial management of these patients and their families.

Adaptation, Psychological

Methods of assessing speech in relation to velopharyngeal function.

Seven speech pathologists with expertise in the evaluation of the speech of individuals with cleft palate agreed that the following parameters should be assessed: case history, oral-peripheral mechanism, articulation, and voice quality. From such information and observations the clinician should be in a position to make inferences about velopharyngeal function. If velopharyngeal function is not normal, it is mandatory that additional information about the mechanism be obtained.

Articulation Disorders

Unresolved issues in velopharyngeal valving.

Although technology for the study and assessment of velopharyngeal function has advanced, we continue to classify that function in simplistic categories: closure, borderline, and no closure. Many questions remain unanswered. Information is needed about the dimensions of closure including depth and orifice configuration as they relate to speech. Under what circumstances does hypernasality involve sound transmission through hypoplastic tissue? Is the configuration of the nasopharynx important to hypernasality? Tension in the speech mechanism and also developmental factors deserve study. Nonsurgical variables that might enhance velopharyngeal function are poorly understood. These and other issues and the means of their investigation are worthy of discussion in our professional forums.

Airway Resistance

Barium sulphate coating of the nasopharynx in lateral view videofluoroscopy.

There is disagreement regarding the usefulness of barium nasopharyngeal coating for clinical velopharyngeal evaluation. One hundred and thirty lateral videofluoroscopic studies performed both with and without barium at the same sitting were reviewed to evaluate multiple structural and functional characteristics of velopharyngeal valving behavior during speech production. Clinical ratings of hypernasality were also available for 105 of the patients studied by x-ray. Agreement between ratings of hypernasality and radiographic evidence of VP incompetency did not differ with respect to the presence or absence of barium. However, velopharyngeal incompetence was generally judged to be greater when the barium coating was used. The barium coating also provided more information as to the presence or absence of Passavant's ridge, generalized posterior pharyngeal wall movement, and palatal asymmetry. However, because the barium may produce artifacts or occasionally obscure structures, we recommend that lateral videofluoroscopy be performed both with and without barium.

Barium Sulfate

Social and psychological problems associated with cleft palate.

There are no compelling studies to support the assumption that people with clefts are seriously disturbed or differ in major ways from their noncleft peers. There is evidence to support that both parents and children pay some high prices for the adjustments and accommodations they ultimately make and that clinicians might smooth the way somewhat by becoming more actively aware of the problems that remain to be addressed in treatment programs to the end that the cleft will become a matter of historical significance rather than of current relevance in the life of the adult.

Achievement

A comparative study of four methods of evaluating velopharyngeal adequacy.

Forty-eight subjects with repaired palatal clefts were divided into three major groups on the basis of speech symptoms and were examined for velopharyngeal valving integrity by means of the R-D nasal manometer, pressure-flow techniques, the Hunter oral manometer, and videofluoroscopy. Videofluoroscopy appeared to provide data that most nearly agreed with predictions of valving made from speech. The Hunter oral manometer was the least useful of the four techniques.

Adolescent