The optimal surgical management for failed conservative measures in epistaxis remains unclear. Given the growing enthusiasm for endoscopic transnasal sphenopalatine artery ligation, it is prudent and timely to evaluate the evidence base for this technique. This study aims to analyse the current evidence for transnasal endoscopic sphenopalatine artery ligation by reviewing the literature and also by comparing the results with other approaches to the management of epistaxis. A detailed literature search identified 11 publications relating to endoscopic sphenopalatine artery ligation. The total number of patients in the pooled series was 127, of which 98% had control of epistaxis following surgery. These results compared favourably to the results of most other techniques used in the modern treatment of epistaxis. Nonetheless, the total number of patients in the 11 case series is small. It is therefore recommended that all units using this technique audit their results to see if the high success rates achieved in the literature are reproducible. If this is the case, then endoscopic sphenopalatine artery ligation may indeed be the surgical answer to intractable posterior epistaxis.

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Systematic literature review regarding efficacy and complication rates of securing nasoenteral tubes with nasal bridles. Studies included: systematic reviews, randomized controlled trials or comparative studies comparing nasal bridles with one or more other method of securing nasoenteral tubes. No restriction on age, language, year of publication or methodology quality was imposed. 18 studies were included. Data extraction was conducted by one reviewer and verified by another. Outcomes evaluated included: rate of tube dislodgement, rate of tube replacement, tube dwelling time, quantified enteral nutrition, cost, complications, and PEG-related morbidity/mortality. Nasal bridling is associated with lower tube dislodgement rate, lower replacement rate and increased length of time of tube in situ, resulting in better delivery of nutrition via nasoenteral tubes secured with nasal bridles compared to conventional methods. However, there is higher incidence of epistaxis/nasal ulceration with nasal bridling compared to conventional methods. Nasal bridle is an easily inserted device that improves nasoenteral tube dwelling time and, subsequently, ability to deliver optimal nutrition.

A variant of a type 2 first branchial cleft anomaly, in which accessory ossicles were found, is described. There follows a discussion of the classification of first branchial cleft abnormalities and how this particular case falls outside the standard classification. CT scanning is mentioned as the investigation that is most useful for defining these abnormalities.

Objective: 1) To evaluate the flexible oesophagogastroduodenoscopy (FOGD) service offered by an ENT department in a university teaching hospital. 2) To determine whether FOGD has significant benefit in patients with LPR. 3) Is TNE (transnasal esophagoscopy) an alternative in this group of patients? Method: Study designed as service evaluation of esophagogastroduodenoscopy performed by the otolaryngologist. Retrospective data were collected from the endoscopy and ENT departments over 2½ years. Included were esophagogastroduodenoscopy performed by an otolaryngologist for laryngopharyngeal reflux. Patients were on proton pump inhibitors (PPI), and some had speech therapy. Results: Data will be analyzed with regard to presenting symptoms, endoscopy findings, management, and follow-up. Outcomes were measured in terms of how many underwent the full procedure as defined by the JAG (Joint Advisory Group) guidelines; accuracy of records; and whether endoscopy findings guided treatment. Was symptom control achieved, and were other treatments required? Outcomes were compared with the literature. The majority of patients benefited in terms of symptom control from initial medical treatment. About 30% required further investigations and/or treatment. The local cost-benefit of flexible esophagogastroduodenoscopy and the possibility of transnasal esophagoscopy as an alternative service are discussed. Conclusion: This project will provide further insight into the flexible esophagogastroduodenoscopy service provided by the ENT team. It is anticipated that recommendations will be beneficial to stakeholders in improving the service to patients, and areas for future research will be identified.