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Biomedical subjects

P Walshe

Publications and source records attributed to P Walshe.

At least 19 recordsLinked to original sources
PubMed2006

Delayed facial nerve palsy following tympano-mastoid surgery: incidence, aetiology and prognosis.

OBJECTIVE: To establish the frequency of occurrence of delayed facial nerve paralysis following tympano-mastoid surgery in our department and to determine the aetiological factors and long term prognosis. SETTING: Tertiary care academic centre. MATERIALS AND METHODS: A retrospective review of all patients who had undergone tympano-mastoid surgery in our department over the previous five years was carried out. A total of 219 patients were included in the study. Only two patients were identified as having delayed onset facial nerve palsy over this period of time. The patients' medical records were reviewed and the patients clinically assessed. RESULTS: The frequency of delayed onset facial nerve palsy following tympano-mastoid surgery in our series was 0.91 per cent. Facial weakness set in on day eight and day 14 in the two patients. Serological investigations in both patients revealed raised titres of immunoglobulin (Ig) M and IgG to varicella-zoster virus, confirming the presence of varicella-zoster infection. In our experience, the combined use of prednisone and acyclovir was an effective form of treatment for both patients, whose facial nerve function fully recovered within six months of onset. CONCLUSION: The incidence of delayed facial nerve palsy following tympano-mastoid surgery is low. It can occur up to two weeks after the surgery. Our two cases confirm viral reactivation to be an important aetiological factor in the development of delayed onset facial nerve palsy. The overall prognosis for delayed facial nerve palsy following tympano-mastoid surgery appears to be good.

Acyclovir↗
PubMed2006

Cervical haematoma after thyroid surgery: management and prevention.

The aim of this study was to evaluate the incidence and circumstances of cervical haematomas complicating thyroid surgery. The second objective was to study the effects of modifying our unit's practice on this complication. The study involved a retrospective chart review of 504 consecutive thyroid operations performed by one surgeon from 1994 to 2005. The operations were carried out in the Professorial units of Otolaryngology Head and Neck Surgery in two teaching hospitals in Dublin, Ireland. Indications for surgery included tumour in 338(67%), airway compromise in 60(12%) and thyroid over-activity in 106 (21%). 116(230/c) patients were male and 388(77%) were females. Ages ranged from 16 to 78 years and the mean age was 34.6 years. 292 (58%) patients had two vacuum drains inserted (eighth inch). 126(25%) had a single drain and 86(17%) patients had no drains used. 44 patients were operated through a small incision (4cms.) with the help of rigid endoscopes (Minimally invasive video assisted thyroid surgery (MIVAT)). During the study period seven patients (1.4%) out of 504 were re-explored due to the development of haematomas. None of the patients needed a tracheostomy. Cervical haematomas developed in 1.4 %/o thyroid surgeries which is consistent with current literature. Predisposing factors like coagulation modifying medications are common and avoidable. Most haematomas develop within 6 hours of surgery. Drains and size of incision do not appear to change the rate of this complication. Strict protocols and training of the care teams is vital.

Adolescent↗
PubMed2005

Virtual laryngoscopy--preliminary experience.

PURPOSE: Computed tomographic virtual laryngoscopy is a non-invasive radiological technique that allows visualisation of intra-luminal surfaces by three-dimensional reconstruction of air/soft tissue interfaces. It is particularly useful when the patient cannot tolerate clinical examination, when infection, neoplasm or congenital defects compromise the lumen and for assessment of the sub-glottic region. We have performed virtual laryngoscopy on patients referred because of upper airway symptoms, and compared the findings with those at conventional laryngoscopy. MATERIALS AND METHODS: Axial scans were obtained using a Toshiba Xpress helical scanner. Virtual laryngoscopy was then performed on a workstation using Toshiba "Fly-thru" software and was completed within 5 min. RESULTS: Pathology included vocal cord nodules, laryngeal cysts, Reinke's oedema, laryngeal neoplasms and leukoplakia. CONCLUSIONS: Virtual laryngoscopy displays anatomical detail comparable to conventional endoscopy. Impassable obstructions are no hindrance and all viewing directions are possible. It is especially useful for providing views of the larynx from below.

Adult↗
PubMed2005

An unusual complication of tonsillectomy.

We report the case of a 30-year-old man who experienced a potentially fatal haemorrhage on the tenth post-operative day after the development of a pseudoaneurysm of the muscular branch of the lingual artery. Due to the nature of the development of these pseudoaneurysms they are difficult to detect until such time that they present with a massive haemorrhage or a rapidly expanding parapharyngeal swelling. There are only several reported cases in the literature to date.

Adult↗
PubMed2005

Parotid masses in patients with previous ear surgery.

This paper describes three cases of patients presenting with lumps in their parotid gland, the origin of which was difficult to define. In each case the past medical history revealed that the patients had undergone previous ipsilateral middle ear surgery. We highlight the fact that where there has been previous incisions in the skin about the ear, there is a risk of epidermal inclusion cysts in the parotid gland. These cysts can occur many years after the initial surgery and therefore may not be identified as an obvious origin to lumps in the parotid gland. Rarely as this series highlights there may also be extension of a cholesteatoma (a collection of keratin which arises from the eardrum and extends into the middle ear space) from the mastoid bone to the parotid gland. We recommend formal ear examination where there is a history of previous ear surgery and an ipsilateral parotid gland lump is present.

Cholesteatoma↗
PubMed2004

An alternative technique for nasal biopsy.

OBJECTIVES/HYPOTHESIS: The objective was to investigate the effectiveness of co-phenylcaine as a topical anesthetic agent for nasal mucosal biopsy. STUDY DESIGN: A prospective study. METHODS: Nasal mucosal biopsy specimens were taken from a site just anterior to the inferior turbinate following topical anesthesia with co-phenylcaine. All volunteers graded pain according to standard visual analogue scale (0-10) (VAS) scoring, and all were followed up after 24 hours for any epistaxis. RESULTS: Ninety nasal biopsy specimens were removed from 41 patients in all. Eight-two percent did not report any discomfort following this procedure (VAS score, 0). Ten patients reported mild discomfort (VAS scores ranging between, 1 and 3) and only six reported pain (VAS scores ranging from 5 to 7). However, five of these patients agreed to further biopsy and documented no discomfort during the repeat procedure. Only one patient required immediate intervention for hemorrhage after the procedure. In cases in which bleeding occurred (seven patients) it was documented within the first 6 hours, was minimal in content, and was controlled with local pressure. No systemic side effects were experienced. CONCLUSION: Co-phenylcaine is a suitable topical anesthetic agent for nasal mucosal biopsy. Removal of nasal tissue from a site anterior to the inferior turbinate can be performed under direct vision and provides sufficient tissue for histological assessment.

Adolescent↗
PubMed2003

Hair cell regeneration in the inner ear: a review.

Hair cell regeneration has been shown to occur in the inner ear of mammals. Specifically, it has been demonstrated in the vestibular system and not the organ of Corti. Recent evidence suggests that the degree of the regenerative response may be augmented pharmacologically. This review discusses the field of hair cell regeneration in fish, amphibians, birds and mammals, and the relationship of regeneration to functional recovery

Amphibians↗
PubMed2003

Manipulation of nasal bone fractures under local anaesthetic.

This article describes the technique of manipulation of nasal bones under local anaesthesia. With increased demand on day ward and in patient hospital beds there is a growing need to treat fractured nasal bones under local anaesthesia at the ENT clinic. Ten patients were treated in this fashion in the out patient setting. All had X rays confirming a fracture of the nasal bones. All ten had an obvious cosmetic deformity of the nose as a result of the fracture. All ten patients underwent satisfactory reduction under local anaesthesia and without the need for intra nasal manipulation to elevate overlapping bones. Reduction of nasal bones in the clinic under local anaesthesia should become the accepted practice where there is a deformity but no overlap of the nasal bones.

Anesthetics, Local↗
PubMed2002

The role of computerized tomography in the preoperative assessment of chronic suppurative otitis media.

Twenty patients awaiting mastoid surgery for chronic suppurative otitis media underwent preoperative high resolution computerized tomography (CT) of the temporal bones. The CT scans were compared with the intraoperative findings. CT was helpful in determining the anatomy of the middle ear and mastoid, and accurately predicted the extent of the disease process in the sinus tympani and facial recess. However, it was unable to distinguish between cholesteatoma, mucosal disease and fluid, and it contributed little to the surgical management of the patients. This suggests that routine preoperative CT scanning of patients before uncomplicated virgin mastoid surgery is of questionable value.

Chronic Disease↗
PubMed2002

The potential of virtual laryngoscopy in the assessment of vocal cord lesions.

Virtual laryngoscopy is a useful adjunctive radiological tool in the assessment of laryngeal lesions. A total of 10 patients requiring direct laryngoscopy for the investigation of laryngeal lesions underwent preoperative virtual laryngoscopy using three-dimensional reconstruction of two-dimensional computerized tomography (CT) images. All lesions were correctly diagnosed on virtual laryngoscopy before direct laryngoscopy. Its main advantages are that it does not require general anaesthesia, it allows three-dimensional visualization of the airway beyond areas of narrowing and it gives a highly accurate representation of vocal cord lesions, both in terms of definition and spatial representation. Its disadvantages are that it does not provide histology, it requires an air-mucosa interface to produce an image and it cannot identify functional lesions of the vocal cords.

Adult↗
PubMed2002

Co-phenylcaine as an alternative to Brompton's solution in rigid nasendoscopy: a pilot study.

BACKGROUND: Rigid nasendoscopy is a diagnostic aid that is frequently used in otorhinolaryngology clinics. Topical local anaesthetic and vasoconstriction is advised prior to the procedure. Options include both Brompton's solution and co-phenylcaine. Brompton's solution contains 10% cocaine, a controlled drug that has potentially serious side-effects. Even deaths have been reported as a consequence of its use as a nasal preparatory agent. OBJECTIVE: To compare the efficacy of cocaine in the form of Brompton's solution versus co-phenylcaine as both a vasoconstrictor and a local anaesthetic in out-patient diagnostic rigid nasendoscopy. METHOD: Thirty-three patients awaiting diagnostic rigid nasendoscopy were recruited to the study. Each patient served as his own control. Co-phenylcaine was delivered as a metered dose of two sprays to one nasal passage and Brompton's solution was delivered on a cotton wool pledget placed in the other nasal passage with the aid of Tilly's forceps. An endoscopist who was unaware of which nasal passage was treated with which agent scored the vasoconstricion at endoscopy 10 min after drug application using a scoring sheet. The patients gave a numerical assessment of how painful the procedure was for each nasal passage. Mean scores were compared using Student's t-test. RESULTS: There was no difference between the two agents with regard to nasal analgesia and vasoconstriction during rigid nasal endoscopy.

Administration, Intranasal↗
PubMed2002

Malignant otitis externa--a high index of suspicion is still needed for diagnosis.

Malignant otitis externa is a destructive inflammatory process of the petrous temporal bone which if untreated leads to osteomyelitis of the skull base and can be fatal. It is more common in immunocompromised and elderly insulin-dependant diabetic patients and is caused by infection with Pseudomonas species. Despite a range of laboratory and radiological tests it still remains difficult to diagnose, particularly in the early stages when it can be treated medically. We describe three cases which presented to this department in the past twelve months. In all cases the diagnosis was made clinically and confirmed per-operatively. Interestingly all three cases were relatively young patients who did not have an immunocompromised status and were not diabetic.

Adult↗
PubMed2001

The use of fibrin glue in refractory coagulopathic epistaxis.

Epistaxis can be particularly difficult to treat when a patient has a coagulopathy, even if the area bleeding is visible. Where routine measures fail to arrest the bleeding (e.g., nasal cautery and packing), the application of fibrin glue is successful in stopping the bleeding without having to address the underlying coagulopathy. Ten patients with epistaxis secondary to an underlying coagulopathy were treated by local application of fibrin glue to the area bleeding. The bleeding stopped immediately in all patients when the fibrin glue was applied. No patients suffered complications. Fibrin glue application should be considered as a cost-effective means of controlling epistaxis from an identifiable area in the nasal cavity in patients with a coagulopathy.

Cost-Benefit Analysis↗