Reviewed on : 23 Jun 2021

Reviewed by : GP Gateway Editor & Joanne Wood Project Manager Coventry and Warwickshire Health and Care Partnership

Expires : 23 Jun 2023

TWO WEEK REFERRAL SERVICES – HEAD AND NECK

Clinical Guidance for Primary Care

LARYNX Persistent unexplained hoarseness lasting for > 3/52

Refer:

• Persistent and progressive change in voice, especially in smokers and it should be a constant symptom

DO not to refer:

• Intermittent croaky voice

Suggested Management

• Laryngitis after URTI (loss of voice) – Voice rest for a week. Steam inhalation, hydration
• Intermittent Voice symptoms-LPR and poor oral hydration – PPI, lifestyle advice, increase frequent hydration for 6/52, routine ENT referral
• Long standing voice symptoms (Cyst/polyp/nodules) – Refer to routine ENT

PHARYNX Unexplained persistent sore throat for >3/52

Refer:

• Ask if discomfort or painful throat – Usually unilateral, progressive pain throat
• Pain while swallowing(odynophagia) – ipsilateral, persistent, and progressive
• Pain in ear while swallowing (referred otalgia) – usually ipsilateral to the side of the cancer

Do not to refer:

• Irritation in throat
• Repeated throat clearing
• Sensation of lump in throat
• Burning sensation in the lower throat

These could be caused by poor oral hygiene, LPR or Globus

Suggested Management

• Frequent hydration
• Gaviscon Advance or similar for 6/52
• Lifestyle advice
• Stop repeated throat clearing
• Information leaflet
• If persistent after 6 weeks with no progressive or new symptoms, consider routine ENT referral
• If patient is around 40 years and develops red flag symptoms, refer on 2ww

PERSISTENT UNEXPLAINED LUMP IN THE NECK >3/52

Refer:

• Palpable neck lump – firm, hard and non-tender
• Recently notices asymmetric tonsils
• With other red flag symptoms

Do not refer:

• Sensation of lump in throat (Globus) with no red flag symptoms

UNEXPLAINED THYROID LUMP

SALIVARY GLAND SWELLING 

Refer:

• Lump with no preceding infection
• Non tender, progressive, well defined palpable lump
• Previous skin cancers with palpable lumps

Do not refer:

• Recent parotitis
• Recurrent parotitis
• Palpable or previous history of salivary calculi

ENT SYMPTOMS:

GLOBUS PHARYNGEUS ASSESSMENT & MANAGEMENT

TINNITUS & VERTIGO

• Not a cancer symptom – routine ENT referral
• If patient needs reassurance for U/L tinnitus – refer for routine MRI Internal Auditory Meatus to exclude Cerebello-pontine lesions

ALLERGIC RHINITIS

• Follow link for further advice https://cks.nice.org.uk/topics/allergic-rhinitis/

Cancer Research UK

On referral consider handing the patient a Cancer Research UK Information Sheet – follow link

Two Week Wait referrals should now be processed through the NHS eReferral Service (previously known as Choose & Book)