BackgroundThe COVID-19 pandemic has necessitated the use of enhanced personal protective equipment (PPE) in healthcare workers in patient-facing roles. We describe the impact on the physical and mental well-being of healthcare professionals who use enhanced PPE consistently.MethodsWe conducted a single-centre, cross-sectional study among healthcare professionals who use enhanced PPE. A web-based questionnaire was disseminated to evaluate the effects on individuals’ physical and mental well-being. Physical and mental impact was assessed through a visual analogue scale.ResultsProspective analysis of the views of 72 respondents is reported. 63.9% were women and 36.1% were men. Physical impact included exhaustion, headache, skin changes, breathlessness and a negative impact on vision. Communication difficulties, somnolence, negative impact on overall performance and difficulties in using surgical instrumentation were reported.ConclusionOur study demonstrates the undeniable negative impact on the front-line healthcare workers using enhanced PPE and lays the ground for larger multicentric assessments given for it to potentially be the norm for the foreseeable future.

Objectives Magnetic resonance imaging scans of the internal acoustic meatus are commonly requested in the investigation of audio-vestibular symptoms for potential vestibular schwannoma. There have been multiple studies into protocols for requesting magnetic resonance imaging for vestibular schwannoma, but none have been reported based on UK National Institute for Health and Care Excellence guidelines for investigating audio-vestibular symptoms. This study intended to identify the local magnetic resonance imaging detection rates and patterns of vestibular schwannoma, and to audit the conformity of scan requests with the National Institute for Health and Care Excellence guidelines, with a review of relevant literature. Method A retrospective analysis of 1300 magnetic resonance imaging scans of the internal acoustic meatus, compared against National Institute for Health and Care Excellence guidelines, was conducted over two years. Results and conclusion Sixteen scans were positive for vestibular schwannoma, with a detection rate of 1.23 per cent. All positive cases fit the guidelines; three of these could have been missed using other criteria. A total of 281 requests did not meet the guideline criteria but revealed no positive results, supporting the use of National Institute for Health and Care Excellence guidelines in planning magnetic resonance imaging scans for audio-vestibular symptoms.

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Introduction Sudden sensorineural hearing loss (SSNHL) is defined as an acute hearing loss occurring within the period of three days (3) with the least magnitude of 30dB or more in three or more contiguous frequencies. Optimum management of SSNHL is disputed. This article attempts to review current literature on the subject and propose a protocol of management. Methods Latest guidelines on the SSNHL were accessed through Google Scholar database and reviewed for appropriateness. Studies assessing the management options were included. Efficacy of interventions were assessed, and recommendations made. Results 17 publications including European Consensus Document and AAO HNS recommendation were assessed. Conclusions 1. Systemic steroids use has a clear definitive recommendation in unison. 2. Intratympanic steroid use has been proposed mainly for salvage therapy. 3. Combined modality treatment options have been used with mixed outcome. 4. Based on the findings a protocol for management of SSNHL is proposed.

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Case overview A patient who got admitted at term for an elective caesarean section underwent an 'on admission' routine nasopharyngeal swabbing for SARS-CoV-2. She developed resistant epistaxis one day after the procedure and was found to have a mucosal injury over the sphenopalatine artery entry point on the left side. She had to undergo an emergency caesarean section followed by endonasal sphenopalatine artery ligation. The epistaxis was successfully dealt with and the mother and baby were discharged 48 hours after surgery. Conclusions Proper training in nasopharyngeal swab technique is required. Departments need to consider having biodegradable nasal packing material for such instances. In such injuries early endonasal sphenopalatine artery ligation (ESPAL) should be considered as traditional methods available to us were not successful.

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We report a case of a 19-year-old female who with tracheal stenosis following prolonged intubation due to organophosphorous poisoning. Crico tracheal resection and end to end laryngotracheal anastomosis was done. She developed quadriplegia on the 2 nd post-operative day. MRI revealed ischemic segment from C3 to T1 segments of spinal cord. We think that the decreased blood flow in the anterior spinal artery with flexion of the neck in combination with hypotension was the direct cause of this major complication. Quadriplegia is a rare complication following Tracheoplasty and should be considered included in the routine consent. Case ReportIn May 2014, a 19year old female was admitted to our hospital with a tracheal stenosis caused by an intentional organophosphorus poisoning in 2013, where she was intubated and had prolonged ventilation at a local hospital. A tracheostomy was done on the 28 th post-operative day and she was de cannulated 3 days after. She developed stridor 4 days after decanulation which warranted a repeat tracheostomy at the local hospital as an endotracheal tube could not be passed due to tracheal stenosis above the level of tracheostomy.Further evaluation at our unit was done and a CT scan of the neck revealed, a long segment narrowing of the trachea from C6 vertebral level up to the tracheostomy site. Fiber optic bronchoscopy revealed a grade 4 tracheal stenosis beneath a normal glottis. Routine preoperative investigations were normal and a tracheal resection planned.During surgery, a sub glottic 4cm long stenotic tracheal segment was identified and tracheal resection with cricotracheal end to end anastomosis was performed. Valsalva maneuver was performed to confirm patency of anastomosis. Relatively less tension was noted over the suture line and routine closure was done. A nasotracheal tube was kept insitu to aid in ventilation and the chin sutured to sternum to prevent undue extension. Post-operative ICU care was given which was uneventful, except one episode of unexplained hypotension, which was corrected with administration of crystalloids.On the 2 nd post-operative day, the patient complained of numbness of both lower limbs. We incidentally noted quadriplegia with a motor level up to the 7 th cervical and sensory level up to the 4 th cervical spinal cord segment. An urgent MRI and MRA of the spinal cord and cervical vertebrae were done. MRI revealed and ischemic segment of the spinal cord partially extending from C3 to T1 spinal cord segments. MRA revealed no abnormality. Her pre-operative and post-operative coagulation studies did not reveal any coagulopathy. She subsequently developed diaphragmatic breathing for which ICU care with ventilation with minimal support was given. She ultimately developed type 1 respiratory failure with concomitant sepsis and died one month after surgery. DiscussionTracheal resection is performed in adults and paediatric age groups with indications ranging from inflammatory, neoplastic, to congenital causes. Bleeding, infection, airway oedema, pulmon...