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Background/Aims Ear, nose and throat services have seen one of the greatest increases in service demand over the last 6 years. This study aimed to determine if a virtual clinic system could reduce the volume of patients who need to be seen in person in an ear, nose and throat outpatient clinic. Methods Clinical outcome data for one consultant's team in a single ear, nose and throat department between 2009–19 were analysed. Data were prospectively collected on all patients who used the virtual clinic in this 10-year period and the outcomes analysed. Results A total of 3071 patients entered the virtual clinic during the 10-year period. Of these, 61% were discharged from the clinic via virtual follow-up and 39% required an in-person review appointment. On average, 187 patients per year did not have to attend an in-person follow-up appointment, with estimated cost savings of £27 000 per year. Conclusions The virtual ear, nose and throat clinic service has clear benefits for patients and services, delivering healthcare without unnecessary in-person appointments through a shared, clinician–patient decision process.

Introduction The auditory brainstem response (ABR) hearing test can be challenging in children with autism spectrum disorder (ASD) due to the inherent behavioral challenges associated with this condition. To attempt to increase our success in sedating ASD patients, we added the use of intranasal Dexmedetomidine (Dexmed) to be used alone or with oral Chloral Hydrate (CH) in an ambulatory care setting, with monitoring by a specialist nurse. Objectives To determine the success and safety of a protocol for ABR testing performed under sedation with intranasal Dexmed and oral chloral hydrate in ASD patients. To compare the success rate, the occurrence of adverse events and time needed to initiate ABR between Dexmed-CH protocol and previous CH-alone protocol in ASD patients. Methods Retrospective review. ASD patients in Dexmed-CH sedation protocol were age- and sex-matched to ASD patients who underwent CH-alone sedation protocol, for comparison. Results 74 ABR records in ASD children were included, 37 patients using Dex-CH protocol and 37 patients using CH-alone protocol. In the Dexmed-CH protocol group, Dexmed was used in 2 different ways: alone as a first choice in patients who refused to swallow CH (9/37), or combined with CH as a rescue (28/37). Under this sedation protocol, 89% of the attempted ABRs were completed successfully with no major adverse effects. In comparison, in ASD patients sedated using the protocol of CH-alone, the success rate significantly lower (69% vs. 89%). The time needed to initiate the test was not significantly different. Conclusion The use of intranasal Dexmed by itself or in combination with CH was a safe and reliable method of performing sedated ABR in ASD patients. Modifying our previous oral CH protocol to include intranasal Dexmed, substantially improved our success rate of sedation in ASD patients in an ambulatory setting. This study may be of significant value to centers worldwide exploring alternatives to general anesthesia for ABR testing in ASD patients.