Warning
Important points in the history

Are symptoms:

  • Noticed between rather than during meals
  • Not aggravated by swallowing
  • Noticed at midline/cricoid supra-sternal notch
  • Intermittent
  • Indicative of acid reflux

These would suggest benign cause.

Important points in examination

On examination does the patient have:

  • Normal oral cavity, head and neck examination
  • No pain
  • No voice problems
  • No pharyngeal problems

If all of the above consider primary care management.

Refer urgently

If patient has any of the following:

  • Abnormal neck examination (e.g. enlarged nodes)
  • Unilateral symptoms
  • Stridor
  • Hoarseness
  • Dysphagia
  • Referred otalgia
  • Smoking/alcohol history

Refer urgently via SCI gateway Head and Neck option.

Primary care management

See points above.

  • Provide reassurance to the patient
  • Advise patient to return if any new symptoms develop
  • Consider PPI as indicated for acid reflux

Editorial Information

Last reviewed: 18/09/2024

Next review date: 18/09/2026

Author email(s): marissa.botma2@nhs.scot.

Reviewer name(s): Marissa Botma.