Undergraduate otolaryngology teaching in the UK is generally limited primarily due to curriculum time constraints with traditional face-to-face (FtF) teaching being restrained by the limitations of time and location. Advances in network technology have opened up new doors for the delivery of teaching in the form of online learning. This study compares a traditional instructor-led lecture with synchronous e-learning (SeL) using otolaryngological emergencies teaching as an educational intervention. A randomised controlled trial was designed involving two groups of medical students attending an otolaryngology emergencies management lecture: one present FtF and the other viewing the streamed lecture online. The primary outcome measure was improvement between pre-and post-lecture test scores. Secondary outcomes comprised the students' ratings of the lecture on a Likert-type scale. Students in both groups had improved test scores following the lecture (p < 0.001 for both groups) and there was no difference in magnitude of improvement in test scores between the two groups (p = 0.168). There was no difference in student ratings between the two groups for the usefulness of the lecture (p = 0.484), interactivity (p = 0.834) and meeting educational needs (p = 0.968). The FtF group, however, was more satisfied overall (p = 0.034). This study demonstrates that SeL may be as effective as FtF teaching in improving students' knowledge on the management of otolaryngological emergencies, and that it is generally positively perceived by medical undergraduates. This highlights the potential utility of e-learning technology in undergraduate otolaryngology training.