Epistaxis remains a major cause of emergency admissions to hospitals. There has been a significant rise in epistaxis admissions with the increasing use of prophylactic anticoagulation for cardiovascular conditions such as atrial fibrillation.Reference Biggs, Baruah, Mainwaring, Harries and Salib1 Two articles in this issue address aspects of epistaxis management. Hall and colleagues present the findings of a multi-centre audit of epistaxis.Reference Hall, Blanchford, Chatrath and Hopkins2 They found that there was considerable variability in epistaxis management between participating departments in respect of examination, surgical intervention and length of hospital stay, with variation from accepted standards. They make the case for a national review of practice in order to improve patient experience and efficiency in delivering emergency care in our most common patient encounter. A second article, by Syed and Sunkaraneni, reviews management of epistaxis in hereditary haemorrhagic telangiectasia; it concludes that there is a lack of evidence for the use of many of the available treatments for this condition.Reference Syed and Sunkaraneni3 The authors propose a flow chart relating the treatment of hereditary haemorrhagic telangiectasia to its clinical severity and document the evidence base (or lack of it) for individual treatments.
Benign paroxysmal positional vertigo (BPPV) is the commonest cause of vertigo requiring patients to be referred to ENT clinics.Reference Lüscher, Theilgaard and Edholm4 The Epley particle repositioning manoeuvre has become the standard treatment for this condition. Hughes and colleagues investigated the number of Epley manoeuvres required for symptom control in BPPV. They found that a single Epley manoeuvre was required in 47 per cent of patients and that 84 per cent of patients experienced symptom relief following three Epley manoeuvres.
Lastly, it is important in modern otolaryngological practice to have adequate equipment for diagnosis available in out-patient clinics. This is particularly relevant given the current reliance on endoscopic diagnosis.Reference Fleming, Al-Radhi, Kurian and Mitchell5 The article by Hussain and colleagues, which sets out minimum requirements for otolaryngology clinics in National Health Service hospitals in the UK, is timely given the political arguments over funding of healthcare and maintenance of standards.Reference Hussain, Baring, Cain, Clement, Dempster and Haddow6
