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1.
FIGURE 10

FIGURE 10. From: Exploration of the views and opinions of health-care professionals and teachers.

Consequences of glue ear for a child with Down syndrome who has glue ear, considered to be the most challenging in terms of management. a, Irreversible tympanic membrane and middle ear problems; assessment/management/validation of management; narrow ear canals; parents choosing a non-surgical management but the child not wanting to wear HAs.

Fortnum H, Leighton P, Smith MD, et al. Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study. Southampton (UK): NIHR Journals Library; 2014 Sep.
2.
FIGURE 8

FIGURE 8. From: Exploration of the views and opinions of health-care professionals and teachers.

Consequences of glue ear for a child with Down syndrome who has glue ear, considered to be the most frequent. a, Iatrogenic complications of repeated grommet surgery.

Fortnum H, Leighton P, Smith MD, et al. Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study. Southampton (UK): NIHR Journals Library; 2014 Sep.
3.
FIGURE 9

FIGURE 9. From: Exploration of the views and opinions of health-care professionals and teachers.

Consequences of glue ear for a child with Down syndrome who has glue ear, considered to be the most significant for the child/family a, Difficulties in understanding the impact of hearing vs. other developmental issues and coexisting conditions.

Fortnum H, Leighton P, Smith MD, et al. Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study. Southampton (UK): NIHR Journals Library; 2014 Sep.
4.
FIGURE 11

FIGURE 11. From: Exploration of the views and opinions of health-care professionals and teachers.

Importance (for professionals) of outcomes from a health research study comparing different treatment options for glue ear in children with Down syndrome. a, Impact of conservative management on irreversible middle ear changes.

Fortnum H, Leighton P, Smith MD, et al. Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study. Southampton (UK): NIHR Journals Library; 2014 Sep.
5.
FIGURE 2

FIGURE 2. From: Exploration of the views of parents.

Aspects of a child’s life and functioning that had been affected by glue ear.

Fortnum H, Leighton P, Smith MD, et al. Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study. Southampton (UK): NIHR Journals Library; 2014 Sep.
6.
FIGURE 12

FIGURE 12. From: Exploration of the views and opinions of health-care professionals and teachers.

Factors influencing decisions on intervention for children with Down syndrome who have glue ear (black bars) and those that have most influence (green bars).

Fortnum H, Leighton P, Smith MD, et al. Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study. Southampton (UK): NIHR Journals Library; 2014 Sep.
7.
FIGURE 13

FIGURE 13. From: Exploration of the views and opinions of health-care professionals and teachers.

Effectiveness of interventions in improving glue ear and/or hearing loss and/or communication difficulties. a, Strategies from family and school to support hearing; T-tubes (long-stay grommet); meatoplasty.

Fortnum H, Leighton P, Smith MD, et al. Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study. Southampton (UK): NIHR Journals Library; 2014 Sep.
8.
FIGURE 3

FIGURE 3. From: Exploration of the views of parents.

Number of parents reporting interventions for glue ear received, and reporting improvement in symptoms. Green bars: number of respondents answering positively for each intervention. Black bars: number of respondents answering positively for the intervention leading to an improvement. a, Other (n = 4): treatment for gastric reflux, speech and language therapy, surgery to remove infected tissue from eardrum, ENT operation (not specified); b, alternative therapy (n = 10): osteopathy, craniopathy, herbal fluid drainage, vapour rub and steam baths, acupuncture, restricted diet and cranial osteopathy.

Fortnum H, Leighton P, Smith MD, et al. Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study. Southampton (UK): NIHR Journals Library; 2014 Sep.

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