This Belgian prospective audit attempted to provide justification for the provision of a 24-hour emergency service at a large 1038-bed teaching hospital (with 31 ENT consultants). The authors looked at a one-month period during which 190 patients were admitted. They found that the majority of admissions (76.4%) were during working hours and 62% were self-referred. Self-referred patients were not more likely to refer themselves at night or on the weekend (OR=1.64 [0.79-3.40], p=0.1841). The mean complaint duration before admission was 7.6 (+/-13.7) days. Mondays and Tuesdays were found to be the busiest days for admissions. Of the total group, 20.5% of patients had a nose or sinus complaint, 36.8% had an ear complaint, and 42.6% had a laryngeal or neck complaint. More than a quarter of patients required no treatment (28.4%), whilst 33.2% had ambulatory treatment, and 24.7% underwent minor ENT procedures within the clinic room. Only 4.2% of patients required surgical treatment. In terms of outcomes, 55.8% of patients had follow-up, 34.2% were referred to another specialty, and 1.6% died. The authors calculated that the immediate treatment of 45 patients outside of normal working hours resulted in an estimated cost saving of 7,300.27 euros. The authors find it justifiable to have 24-hour emergency ENT coverage with a fully equipped ENT room, an important conclusion given the increasing pressure on finite resources.