What criteria should I use to determine if a patient with a sore throat requires referral to an ENT specialist?

Referral to an ear, nose, and throat (ENT) specialist for a patient presenting with a sore throat should be considered when there are persistent or unexplained neck lumps, especially if the lump is increasing in size or associated with systemic symptoms such as fever, night sweats, weight loss, pruritus, or alcohol-induced lymph node pain, as these may indicate lymphoma or other malignancies ¹.

Urgent referral is also warranted if there is persistent unexplained lymphadenopathy in adults, particularly if supraclavicular or cervical and the patient is aged 40 or over, due to the risk of head and neck cancers or lung cancer ¹.

Additional criteria include unexplained oral cavity ulceration lasting more than 3 weeks, or lumps in the lip or oral cavity suspicious for cancer, which require urgent specialist assessment ¹.

In children and young people, unexplained generalized lymphadenopathy with systemic symptoms such as night sweats or pruritus should prompt very urgent referral for specialist assessment ¹.

Furthermore, if the sore throat is accompanied by sudden or rapidly worsening hearing loss, unilateral hearing loss with neurological signs (e.g., facial droop), or otalgia with otorrhoea unresponsive to treatment, immediate referral to ENT is indicated ².

From the clinical literature perspective, referral is advised when sore throat symptoms are severe, persistent, or complicated by airway obstruction, peritonsillar abscess, or other complications requiring specialist intervention (Harris, 2002).

In summary, the key criteria for ENT referral in sore throat patients include persistent or unexplained neck lumps, systemic 'B' symptoms suggestive of malignancy, suspicious oral lesions, and associated ENT complications such as hearing loss or abscess formation ¹,²(Harris, 2002).