• Clinical image: keratitis in reactive arthritis.

      Collins, Niamh E; Fitzgerald, Oliver; Murphy, Conor C; Royal Victoria Eye and Ear Hospital, Royal College of Surgeons Ireland, Dublin,, Ireland. (2012-02-01)
    • Clinical observations associated with proven and unproven cases in the ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery.

      Barry, Peter; Gardner, Susanne; Seal, David; Gettinby, George; Lees, Fiona; Peterson, Magnus; Revie, Crawford; Royal Victoria Eye and Ear Hospital, Dublin, Ireland. peterbarryfrcs@eircom.net (2012-02-01)
      PURPOSE: To describe cases of postoperative endophthalmitis in the European Society of Cataract & Refractive Surgeons (ESCRS) study of the prophylaxis of endophthalmitis, compare characteristics of unproven cases and cases proven by culture or polymerase chain reaction, and compare the characteristics with those in other reported series. SETTING: Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom. METHODS: Univariable and multivariable logistic regression models were used to analyze data for statistical association of signs and symptoms in cases with proven or unproven endophthalmitis. Specific data describing characteristics of the cases were compared between the 2 types of cases. RESULTS: Data from 29 endophthalmitis cases were analyzed. Swollen lids and pain were statistically associated with proven cases of endophthalmitis on univariable regression analysis. Multivariable analysis indicated that swollen lids and an opaque vitreous were associated with proven cases. Five cases of endophthalmitis occurred in the cefuroxime-treated groups. No case of streptococcal infection occurred in the cefuroxime-treated groups. However, cases of infection due to streptococci showed striking differences in visual acuity and were associated with earlier onset. Characteristics in the 29 cases parallel results in previous studies, such as the Endophthalmitis Vitrectomy Study, although the addition of a control group in the ESCRS study elicited additional findings. CONCLUSION: Swollen lids, pain, and an opaque vitreous were statistically associated with proven endophthalmitis cases in the ESCRS study.
    • The effect of gastric decompression on postoperative nausea and emesis in pediatric, tonsillectomy patients.

      Chukudebelu, O; Leonard, D S; Healy, A; McCoy, D; Charles, D; Hone, S; Rafferty, M; Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Adelaide Road,, Dublin 2, Ireland. BBChukud@yahoo.com (2012-02-01)
    • Effect of tonsillectomy on the adult voice.

      Heffernan, Colleen B; Rafferty, Mark A; Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, Ireland., heffernan_colleen@hotmail.com (2012-02-01)
      OBJECTIVES AND HYPOTHESIS: Anecdotal evidence suggests that tonsillectomy has no deleterious consequences on a person's voice under normal vocal demand. However, whether the enlarged dimensions of the oropharynx after tonsillectomy impair the quality of a professional voice user remains unclear. Therefore, we designed a study to determine whether adult tonsillectomy altered the resonance characteristics of the vocal tract in any way and whether these changes were transient or permanent. STUDY DESIGN: This is a prospective observational study with full institutional ethical approval. METHODS: All adult patients presenting for tonsillectomy for recurrent tonsillitis in our institution were recruited. Their voice was recorded preoperatively, postoperatively, and at 4 weeks postoperatively. The values of the first four formants were calculated in all recordings. The oropharyngeal dimensions were measured preoperatively and postoperatively. Tonsillar weights and volumes were also measured. RESULTS: The first formant was noted to rise postoperatively. The average value of F2 and F3 did not alter postoperatively or at 4 weeks. However, it was noted that the fourth formant was not universally present preoperatively but was present in all patients postoperatively and at 4 weeks. CONCLUSIONS: Altering the dimensions of the oropharynx after tonsillectomy causes the first formant to rise but has no effect on the third and fourth formants. However, the fourth formant appears in patients who previously did not demonstrate it. The fourth formant was present in a greater proportion of male patients preoperatively than female patients, but it was universally present postoperatively and at 4 weeks in both sexes. This suggests that increasing the horizontal dimensions of the oropharynx has a nontransient effect on the higher order formants of the voice.
    • A method for the prescription of inexpensive spectacles by non-specialist healthcare workers: S-Glasses.

      Treacy, M P; Treacy, M G; Dimitrov, B D; Seager, F E; Stamp, M A; Murphy, C C; Department of Ophthalmology, Royal College of Surgeons in Ireland, Royal Victoria Eye and Ear Hospital, Dublin 2, Republic of Ireland. Max@Treacy.ie (2013-04)
      Globally, 153 million people are visually impaired from uncorrected refractive error. The aim of this research was to verify a method whereby autorefractors could be used by non-specialist health-workers to prescribe spectacles, which used a small stock of preformed lenses that fit frames with standardised apertures. These spectacles were named S-Glasses (Smart Glasses).
    • Minimally invasive video-assisted parathyroidectomy.

      Casserly, Paula; Timon, Conrad; Department of Otolaryngology/Head and Neck Surgery, Royal Victoria Eye and Ear, Hospital, Dublin, Ireland. paulacasserly@hotmail.com (2012-02-01)
    • Nd:YAG laser hyaloidotomy for valsalva pre-macular haemorrhage.

      Kirwan, R P; Cahill, M T; Department of Ophthalmic Surgery, The Royal Victoria Eye and Ear Hospital,, Adelaide Road, Dublin 2, Ireland. ruaidhri.kirwan@ucd.ie (2012-02-01)
      AIM: To report a case of successful drainage of a large pre-macular haemorrhage using laser photo-disruption of the posterior hyaloid membrane. MATERIALS AND METHODS: A case report. RESULTS: A 47-year-old man presented acutely to our emergency department complaining of a 24-h history of sudden onset, painless and persistent loss of vision in his left eye. Immediately before noticing this loss of vision, he had been vomiting violently from excessive alcohol intake. The left visual acuity was counting fingers. Dilated fundoscopy of the left eye revealed a large pre-macular haemorrhage which was 14 disc diametres in size. Clotting investigations were normal. A diagnosis of valsalva retinopathy was made and the patient elected to receive a prompt neodymium-doped yttrium aluminium garnet (Nd:YAG) laser posterior hyaloidotomy as an outpatient. At 1 week follow-up, the haemorrhage had drained completely into the vitreous space revealing a healthy macula and the visual acuity had improved to 6/12 unaided. At 6-month follow-up the left visual acuity stabilised at 6/9 unaided. CONCLUSION: Nd:YAG laser posterior hyaloidotomy is a useful outpatient procedure for successful clearance of large pre-macular haemorrhages that offers patients rapid recovery of visual acuity and the avoidance of more invasive intraocular surgery.
    • A novel homozygous truncating GNAT1 mutation implicated in retinal degeneration.

      Carrigan, Matthew; Duignan, Emma; Humphries, Pete; Palfi, Arpad; Kenna, Paul F; Farrar, G Jane (2016-04)
      The GNAT1 gene encodes the α subunit of the rod transducin protein, a key element in the rod phototransduction cascade. Variants in GNAT1 have been implicated in stationary night-blindness in the past, but unlike other proteins in the same pathway, it has not previously been implicated in retinitis pigmentosa.
    • Oncogenic impact of human papilloma virus in head and neck cancer.

      Heffernan, C B; O'Neill, J P; Timon, C; The Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, Ireland., Heffernan_colleen@hotmail.com (2012-02-01)
      There is considerable debate within the literature about the significance of human papilloma virus in head and neck squamous cell carcinoma, and its potential influence on the prevention, diagnosis, grading, treatment and prognosis of these cancers. Cigarette smoking and alcohol consumption have traditionally been cited as the main risk factors for head and neck cancers. However, human papilloma virus, normally associated with cervical and other genital carcinomas, has emerged as a possible key aetiological factor in head and neck squamous cell carcinoma, especially oropharyngeal cancers. These cancers pose a significant financial burden on health resources and are increasing in incidence. The recent introduction of vaccines targeted against human papilloma virus types 16 and 18, to prevent cervical cancer, has highlighted the need for ongoing research into the importance of human papilloma virus in head and neck squamous cell carcinoma.
    • Orbital exenteration in periorbital malignancies.

      Roche, Phoebe; Timon, Conrad; Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland. phoebe.roche@yahoo.co.uk (2012-08)
      Orbital exenteration is a disfiguring procedure most commonly performed for locally advanced or recurrent periorbital malignancies.
    • Outcome measures and scar aesthetics in minimally invasive video-assisted parathyroidectomy.

      Casserly, Paula; Kirby, Rachel; Timon, Conrad; Department of Otolaryngology-Head and Neck Surgery, Royal Victoria Eye and Ear, Hospital, Dublin, Ireland. paulacasserly@hotmail.com (2012-02-01)
      OBJECTIVES: To compare the scar outcome of video-assisted parathyroidectomy (VAP) with traditional bilateral cervical exploration (BCE) using previously validated scar assessment scales, and to examine the feasibility of introducing VAP into a general otolaryngology-head and neck practice. DESIGN: A retrospective review of medical records from a prospectively obtained database of patients and long-term follow-up of scar analysis. PATIENTS: The records of 60 patients undergoing parathyroidectomy were reviewed: 29 patients underwent VAP and 31 patients underwent an open procedure with BCE. The groups were matched for age and sex. A total of 46 patients were followed up to assess scar outcome. MAIN OUTCOME MEASURES: The primary outcome was a comparison of patient and observer scar satisfaction between VAP and traditional BCE using validated scar assessment tools: the Patient Scar Assessment Scale and the Manchester Scar Scale. The secondary outcomes were to retrospectively evaluate our results with VAP and to assess the suitability of introducing this technique into a general otolaryngology-head and neck practice. RESULTS: The average scar length in the VAP group was 1.7 cm, and the average scar length in the BCE group was 4.3 cm. The patients in the BCE group scored higher than the patients in the VAP group on the Manchester Scar Scale (P < .01) and on the Patient and Observer Scar Scales (P = .02), indicating a worse scar outcome. The mean operative time in the VAP group was 41 minutes compared with 115 minutes in the open procedure BCE group. There was no difference between the 2 groups in terms of postoperative complications. CONCLUSIONS: Video-assisted parathyroidectomy is a safe and feasible procedure in the setting of a general otolaryngology-head and neck practice, with outcomes and complication rates that are comparable to those of traditional bilateral neck exploration. Both patient and observer analysis demonstrated that VAP was associated with a more favorable scar outcome when compared with BCE.
    • Patients' quality of life post thyroidectomy.

      Cashman, E C; Bresnihan, M; Timon, C; Royal Victoria Eye & Ear Hospital, Adelaide rd, Dublin 2, Ireland. emmacashman@gmail.com (2011)
      This study was designed to evaluate health related quality of life post thyroidectomy for hyperthyroidism with respect to clinical benefit and patient satisfaction. This is one of the first such studies in the literature evaluating quality of life post thyroidectomy for hyperthyroidism.
    • A rare angiosarcoma: retiform haemangioendothelioma.

      O'Duffy, F; Timon, C; Toner, M; Department of Otorhinolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland. fergaloduffy@hotmail.com (2012-02)
      We report the case of a rare angiosarcoma, retiform haemangioendothelioma, in an 18-year-old young man, which presented as a recurrent ulcerating lesion of the left pinna.
    • Selective fine needle aspiration of parotid masses. FNA should be performed in all patients older than 60 years.

      Kieran, S M; McKusker, M; Keogh, I; Timon, C; Department of Otolaryngology, Head and Neck Surgery, Royal Victoria Eye and Ear, Hospital, Dublin, Ireland. skieran@rcsi.ie (2012-02-01)
      OBJECTIVES: The exact role of fine needle aspiration in the pre-operative assessment of patients presenting with parotid masses is controversial. Some surgeons propose that fine needle aspiration be performed only selectively in those patients with likely malignant disease, whilst others recommend it for all patients presenting with such a mass. Intuitively, one would expect older patients to be more likely to suffer from primary malignant parotid tumours and secondary deposits of malignant skin tumours. Therefore, we hypothesised that older patients with a parotid mass should undergo fine needle aspiration regardless of their medical history. DESIGN: We retrospectively reviewed 197 consecutive parotidectomies to test this hypothesis. RESULTS: One hundred and twenty-one patients (61.4 per cent) were diagnosed with benign disease, whilst 76 (38.6 per cent) were diagnosed with malignant disease. Eighty-three per cent of patients aged 60 years or younger had benign disease, as opposed to 35.6 per cent of patients aged more than 60 years. Malignant disease occurred more commonly in patients older than 60 years (odds ratio 8.962, 95 per cent confidence interval 4.607-17.434). CONCLUSION: In patients with a parotid mass, fine needle aspiration should be performed on all those aged 60 years or older.
    • "Tarantula keratitis": a case report.

      McAnena, L; Murphy, C; O'Connor, J; Royal Victoria Eye and Ear Hospital (RVEEH), Adelaide Road, Dublin 2, Ireland. lmcanena@yahoo.co.uk (2013-09)
      A case of an 11-year-old boy presenting with a two-week history of a red, irritated right eye after handling a Chilean Rose Tarantula at an exotic pet exhibition. Examination revealed innumerable microscopic hairs embedded at all levels of the cornea. He was commenced on steroid drops with subjective and objective improvement at follow up.
    • Triple manifestation of extramedullary plasmacytoma in the upper airway: an unusual clinical entity.

      Morariu, I; Burns, P; Roche, P; Hone, S; Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin,, Ireland. iulianam2002@yahoo.com (2012-02-01)
      OBJECTIVE: We report an extremely rare case of extramedullary plasmacytoma. METHOD: Case report and review of the English-literature concerning extramedullary plasmacytoma and multiple myeloma. RESULT: We present an unusual case of multiple extramedullary plasmacytomas, which, over a protracted course of 30 years, presented on different occasions at three separate sites in the head and neck. The patient was managed surgically on all occasions, and was disease-free at the time of writing. CONCLUSION: Following review of the literature, we believe this to be the only case with this extremely unusual presentation. This case is noteworthy, not only because of the rarity of extramedullary plasmacytoma, but also because it highlights a number of important clinical issues. The diagnosis and management of extramedullary plasmacytoma require close cooperation between multiple disciplines.