The only specialised Accident and Emergency unit for ENT in Ireland is at The Royal Victoria Eye and Ear Hospital, Dublin. This provides a service for the entire Republic, operating on a 9 am to 5 pm, Monday to Friday, basis. The aim of the present study was to define the role of this specialised unit. A prospective study of the service over a one month period was conducted. During this time 779 patients were seen of which 350 (45%) were new patients and 429 (55%) were return patients. Fifty two per cent were self referred, 35% were referred by their General Practitioners, 8% by other hospitals and 5% from other sources. The most common diagnosis was otitis externa (21% of new patients and 63% of returns), followed by ear wax (15% of new patients), and epistaxis (9% of new patients). Five per cent of patients required removal of foreign bodies from their ear, nose or oesophagus, and 3% received treatment for trauma to these regions. Of note during this period six new cases of head and neck cancer were detected. From these figures it is the authors' opinion that many of the problems seen could have been dealt with by General Practitioners or as non-emergency referrals to the out-patient department. This indicates the need for further training for primary care physicians and expansion of the present outpatients services. The specialised casualty service should continue to exist to provide a genuine emergency service and valuable training in the speciality.