Endoscopic sphenopalatine foramen cauterization is an effective treatment modification of endoscopic sphenopalatine artery ligation for intractable posterior epistaxis.

PURPOSE: Endoscopic sphenopalatine artery ligation (ESPAL) is known as an effective treatment for posterior epistaxis. Anatomical variations of the intranasal branching may result in long operative time and possible inadequate cauterization. A modification of ESPAL by cauterization at the sphenopalatine foramen (SPF), has been performed by our group. Our study assessed the clinical benefit of endoscopic sphenopalatine foramen cauterization (ESFC) and compared it to ESPAL. METHOD: A retrospective study was conducted. Patients who received ESFC for posterior epistaxis from 2016 to 2018 at a tertiary hospital were recruited. Middle meatal antrostomy was done. After ethmoidal crest was identified and nipped, pterygopalatine fossa was entered through the SPF. Sphenopalatine artery (SPA) and its branches within the SPF were cauterized without identification of any SPA distal branches in the nasal cavity. Patients receiving conventional ESPAL by the same surgeon were recruited and compared as control. Patients were followed-up for 3 months. Success rate, operative time, and complication were assessed. RESULTS: Thirty-four patients were identified. Recurrent epistaxis was absent in 90.0% and 100% of patients receiving ESPAL (9/10 patients) and ESFC (24/24 patients) respectively, p = 0.294. Median operative time was 115 and 60 min, respectively, p < 0.001. Ipsilateral hard palatal or anterior palatal numbness were found in one and three patients, respectively. All resolved spontaneously within 2 weeks. CONCLUSION: ESFC is effective in treating posterior epistaxis. It requires significantly less amount of time while the success rate was comparable to conventional ESPAL.

The effect of the COVID-19 pandemic on non-elective otolaryngology admissions and a positive change in clinical practice.

As the COVID-19 pandemic progressed across the UK and Northern Ireland in March 2020, our otolaryngology department began to make preparations and changes in practice to accommodate for potentially large numbers of patients with COVID-19 related respiratory illness in the hospital. We retrospectively reviewed the number of non-elective admissions to our department between the months of January and May in 2019 and 2020. A significant reduction in admissions of up to 94% during the months of the pandemic was observed. Our practice shifted to manage patients with epistaxis and peritonsillar abscess on an outpatient basis, and while prospectively collecting data on this, we did not observe any significant adverse events. We view this as a positive learning point and change in our practice as a result of the COVID-19 pandemic.