Keywords Flexible nasendoscopy, COVID-19, upper aerodigestive tract, aerosol generating procedure Objectives Flexible nasendoscopy (FNE) is an invaluable multi-disciplinary tool for upper aerodigestive tract (UADT) examination. During the COVID-19 pandemic concerns were raised that FNE had the potential of generating aerosols resulting in human cross-contamination when performed on SARS-COV2 carriers. ENT UK issued guidelines restricting FNE to essential cases, specifying that FNE should be performed in a well-ventilated room, preferably with a monitor screen and wearing enhanced PPE. We surveyed ENT UK members and Royal College of Speech and Language Therapists (RCSLT) members to determine the impact of the COVID-19 pandemic on FNE practice of the UADT. Design An observational internet-based survey Setting FNE practice in community clinics, outpatient departments, inpatient wards, ICUs, emergency departments and operating theatres. Participants UK-based ENT surgeons and speech and language therapists using FNE in clinical practice. Main outcome measures Frequency, indication and local guidelines of FNE of the UADT before, during and emerging from the COVID-19 first peak. Results 314 responses: 82% from ENT clinicians, 17% from SLTs and 1% from nurse practitioners (NP) and physician associates (PA). Overall, there has been a large reduction in the volume and indications for FNE during the first peak of the COVID-19 pandemic with limited recovery by mid-August. Cancer and airway assessments were impacted less. A wide range of FNE protocols are reported varying in choice of endoscope, extent of PPE and sterilization methods. Recommended practice appears influenced predominantly by local factors. The majority of services used reusable endoscopes manually cleaned with Tristel wipes or sent for central sterilization at non-uniform intervals, while a minority of services exclusively used single-use video-endoscopes. When there was no dedicated AGP rooms, centers managed with simple window opening and a widely variable room “down-time” between patients. Endoscope preference reflected user familiarity. ENT trainees expressed a preference for single-use video capturing endoscopes for continuing service models. Conclusion Despite guidance, local practice of FNE remains interrupted and highly variable nationally. A collaborative approach is required to re-introduce FNE safely across UK healthcare setting to ensure timely diagnosis and optimal patient care.

Background Current shortage of operative space and anaesthetic staff led to 531907 ENT cases waiting to be performed as of June 2022; a trend expected to worsen. Awake surgery can provide a safe and effective alternative reducing the need for anaesthetic cover while utilising alternative operating spaces. Methodology Prospective cohort study of 86 patients undergoing ENT procedures under local anaesthetic with/without operator delivered sedation using midazolam; performed in the ambulatory Procedure Zone of an ENT tertiary centre in the UK by a single sedation trained rhinologist. Results N=54 inferior turbinate reduction (n=19 with radiofrequency ablation, n=25 with co-ablation, n=13 combined with a second procedure). Pre-operative mean SNOT23 score 59, mean NOSE score of 17.89, 3 month post-operative mean SNOT 23 score 36 and mean NOSE score 7.92 (P<0.05). N=18 balloon sinoplasty, n=4 endoscopic sinus procedures; pre-operative mean SNOT23 score 76, 3 month post-operative mean SNOT23 score 25 (P<0.05). N=12 nasal biopsies, n=8 septoplasties, n=6 adhesiolysis, n=1 grommet insertion, n=1 excision of pinna lesion, n=1 canal polypectomy. Visual analogue scale was used to assess patient comfort during the procedure; 4/10 mean score (IQR 2-8) for cases under local anaesthetic ranged, with addition on sedation comfort increased with mean score of 8/10 (IQR 1-10). Due to the low numbers of cases statistical significance was not calculated. Conclusion Awake surgery in ENT is a safe and effective alternative to general anaesthesia. It is a cost effective service, which shortens waiting and treatment times, and coupled with operator delivered sedation leads to high patient satisfaction rates.