Impact of COVID‐19 on the mental health of surgeons and coping strategies

Unprecedented times call for extraordinary measures. While surgeons across the globe try to comprehend the evolving facade of the COVID‐19 pandemic and improvise surgical practice to the best of their ability, the psychological impact of the stress on their own mental health and well‐being has been underestimated. This paper aims to review the indirect and overt factors that may affect the mental health of a surgeon in the present circumstances. Furthermore, it will aim to highlight key coping mechanisms at an individual and institutional level, so as to mitigate the negative psychological impact on surgeons.     

A patient with dry mouth

Introduction: Xerostomia is a common symptom among patients referred to ENT clinics. We present an evidence‐based approach in a patient complaining of xerostomia who has not been exposed to radiotherapy. Method (search strategy): This review was based on a literature search last performed on 1 July 2008. MEDLINE and EMBASE databases and the Cochrane Library were searched using the subject headings dry mouth, hyposalivation and xerostomia in combination with diagnosis, therapy and surgery. Results were limited to English language articles including clinical trials, randomised controlled trials, meta‐analyses, systematic reviews, review articles and human studies. Relevant references from selected articles were reviewed. Results: Xerostomia is not synonymous with hyposalivation. Effective management covers symptomatic relief with selected saliva substitutes, sialogogic agents, addressing underlying dental complications and oral infections, and review of prescribed medication. Conclusion: Xerostomia is a common symptom for a wide range of triggering factors, but the treatment is largely palliative and preventative in nature.     

Defining the stenotic post‐laryngectomy tracheostoma and its impact on the quality of life in laryngectomees: development and validation of a stoma function questionnaire

Objectives: The aims of this study were to identify if: (i) size of stoma contributes to quality of life (QoL) in laryngectomees; (ii) stoma size has an impact on routine stoma care and function; and (iii) an optimal stoma size exists below which patients experience stoma problems. Design: Cross‐sectional study of laryngectomees. Setting: Two tertiary care centres. Participants: Fifty‐seven patients who had undergone total laryngectomy one to five years ago and using tracheo‐oesophageal speech as their primary communication means. Main outcomes measures: Three main measures were studied: 1 a new study specific questionnaire designed to assess problems with function and care of the end tracheosto‐ ma; 2 QoL as assessed by the head and neck QoL instrument; 3 a precision custom designed sizer to measure the minimum stoma diameter. Results: The final study‐specific questionnaire contained four items assessing different aspects of stomal function. From raw total scores an overall stomal score was generated. The stoma score was moderately correlated to emotion and speech domains in head and neck Quality of Life questionnaire, indicating that different concepts were being measured. The mean minimum stoma diameter was 15.9 ± 2.9 mm. There was a significant increase in the area under the receiver operating characteristic curve beyond a threshold value of ≥15 mm; smaller sizes were associated with a poorer stoma score (Mann–Whitney test, P < 0.001). No patient found the stoma sizer use distressing. Conclusions: Size of stoma significantly contributes to QoL in laryngectomees and stomas with minimum diameters of 14 mm or less are associated with adverse effects on routine stoma function. The study‐specific stoma function questionnaire appears to be a useful instrument.     

Spontaneous temporal encephaloceles masked by dual pathology: report of two cases.

Spontaneous temporal meningoencephaloceles are rare entities and diagnostic difficulties can occur. We present two cases whose presentation was atypical and diagnosis delayed by the presence of dual pathology.