Neck Lumps

 

Further information relating to each of these conditions can be found on the guideline ‘Head and Neck USS’ 

 

Overview of referral pathways

 

 

Click here for Thyroiditis referral guidelines

ENT 2WW referral

USS NOT required prior to referral (and may delay patient being seen), but if is has been done please include details in the referral letter.

• Previously un-investigated, unexplained PALPABLE lump in the neck (including thyroid, parotid and submandibular glands)
• Unexplained persistent (>4 weeks) sore or painful throat (especially with otalgia)
  (NOT for globus or throat discomfort)
• Persistent (>3weeks) unexplained hoarseness and age ≥ 45yrs

 

 

Routine USS prior to ENT Head & Neck referral

Thyroglossal duct cyst:

• Often asymptomatic, mobile midline neck mass at/below level of hyoid bone
• Mass will elevate with tongue protrusion or swallowing

Routine neck USS should be requested where you are confident that the neck lump fits the above clinical picture, in a patient withoutany red flag features. Once the diagnosis is confirmed, please refer routinely to the Head & Neck service.

Of course, other neck lumps can present similarly, therefore if there is any diagnostic uncertainty, please refer to the flowchart of neck lumps above.

 

 

Routine ENT Head & Neck referral

USS NOT required prior to referral or as part of primary care management.

 

1. Globus Sensation: 

• Globus sensation (or globus pharyngeus) is a subjective feeling of a lump or foreign body in the throat
• Alternative referral pathway is via the Urgent Throat Symptoms Assessment Clinic

 

2. Benign salivary gland pathology, e.g. sialadenitis, sialolithiasis

• Manage in primary care: symptoms relatively infrequent and resolve spontaneously or with conservative treatment
• See https://patient.info/doctor/salivary-gland-disorders for information on benign causes and management
• Refer routinely to ENT or Max-Fax: symptoms persist or recur frequently despite conservative management

 

 

ENT Advice & Guidance Service

Where patients fall outside of these referral criteria or there are questions with regard to community management, please utilise the ENT Advice and Guidance service.

 

 

Review Date                  January 2022

Next Review Date          January 2023

GP Sifter                        Dr Laura Vines

Contributor                     Mr Venkat Reddy, Consultant ENT Surgeon

                                       Dr Ben Rock, Consultant Radiologist

Version                           2.0