Is there evidence to support early discharge of patients with tonsillitis, quinsy and epistaxis?
Reviewed by Madhup K Chaurasia

The COVID-19 pandemic, with its unprecedented pressures on the NHS, demands changes in the management of common ENT emergencies. In this review article, information has been gleaned from 22 relevant articles on how this can be done. The Portsmouth tonsillitis protocol has been detailed. Unless patients presenting with acute tonsillitis have associated risk factors, they are treated with fluids, benzylpenicillin, dexamethasone and paracetamol given intravenously along with oral diclofenac sodium and difflam. If after two hours they can swallow and are stable, they are discharged on the same medications, except steroids, to be taken orally. Outpatient management pathways have been mentioned for patients with peritonsillitis, with only 12% requiring in-patient admission after successful aspiration. First aid treatment and cautery can allow most epistaxis patents to go home. Majority of bleeding after pack removal occurs within four hours, hence discharge can be made earlier. Ninety percent success was achieved with use of Floseal which allowed patients to go home in 2.75 hours. Evidence also supports use of tranexamic acid. More evidence is required on use of other topical haemostatic agents e.g., microporous polysaccharide hemospheres (Arista) and timing for removal of packs needs to be standardised. Although the pandemic has urged us to change our methods, there is no reason why these modifications cannot be applied permanently to reduce pressure on the NHS.

Ambulatory management of common ENT emergencies- what’s the evidence?
Heining C J, Amiani A and Doshi J.
J LARYNGOL OTOL
2021;135(3):191-5.