The aim of the study was to determine if petroleum jelly was an effective treatment for paediatric epistaxis. A single-blind, prospective, randomized controlled trial was undertaken in an otolaryngology outpatient clinic of a paediatric hospital from March 2001 to March 2002. A total of 105 children referred with recurrent epistaxis were randomized into the study, 52 into the treatment arm and 53 into the control arm. Children in the treatment arm applied Vaseline twice a day bilaterally for 4 weeks and were monitored for any bleeds for the next 4 weeks. Children in the control arm were simply given an 8-week appointment and the number of bleeds were monitored for the 4 weeks prior to their appointment. The outcome measure was the proportion of children in each group without nosebleeds in the preceding 4 weeks. Both groups were equally distributed in age, duration of symptoms and duration of each bleed. Fourteen of 51 (27.5%) patients of the treatment arm and 18 of 53 (34%) of the control arm did not bleed in the 4 weeks before review (chi-square test, P = 0.472). It can be concluded that Vaseline alone confers no benefit over simple observation in recurrent childhood epistaxis.

Nose drops are commonly prescribed in the United Kingdom, yet clinicians vary considerably in the instructions they give on how to instill them. This is important because how they are used affects how well they work. In this study, a visual assessment of the intranasal distribution of drops was made using endoscopic examination after the instillation of betamethasone drops containing methylene blue. Drops instilled with the head tipped back were found along the nasal floor and in the nasopharynx, with none visible in the middle meatus or elsewhere on the lateral nasal wall. Drops instilled in Mygind's position or in the praying-to-Mecca position were found predominantly in the middle meatus and on the middle and inferior turbinates. No difference was seen between these two positions in the distribution of drops achieved, and this is likely to lead to similar clinical efficacy. Because Mygind's position is much more comfortable for patients, it should be recommended by all doctors prescribing nose drops.

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It has been suggested that more otolaryngologic procedures should be performed on an outpatient basis, and that rigid upper aerodigestive tract endoscopy might be a particularly suitable procedure in this regard. To determine ifthis is indeed the case, we retrospectively reviewed the records of563 patients who had undergone 655 rigid esophagoscopies in our unit between Jan I, 1991, and July 31, 1998. We ascertained the rate of compli cations (primarily esophageal perforation) following such procedures and, when they did occur, we determined the length of time between surgery and the onset of the complications ' signs and symptoms. Our aims were to establish the minimum duration of postoperative observation that is required followin g esophagoscopy and to propose criteria for safe same-day discharge. We found that perforation rates were 4.5% following therapeutic procedures (dilation, biopsy, andforeign-body removal) and I.2 %following diagnostic pro cedures. In 40 % ofthe patients who experienced perforations, no such signs or symptoms were noted within the first 8 hours following surgery. This f inding has important implications for surgeons who wish to perform rigid esophagoscopy on an outpatient basis.

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