1. I.V. antibiotics and hospitalization are tempered by clinical judgement. Some cases are safely treated with an office dose of systemic antibiotics followed by oral antibiotics. Some cases are safely managed with home health. I.V. antibiotic treatments. Sick patients or "dangerous" infections require hospitalization.
   
   
2. No diagnosis may mean a benign or malignant process. The larger the mass, the harder the mass or the more likely it could be malignant or progressing, the earlier should the ENT referral be made.

Overview of Neck Masses

The only easy way to diagnose a neck mass is to know exactly what the patient has before you begin. Then, your only challenge is to prove it. The next most challenging is to have some idea of what the patient has, perform a few tests, narrow the differential, and then prove the final diagnosis. The most challenging is to have absolutely no idea whether this is a benign lymph node, malignant tumor or an absolutely bizarre infectious disease. Probably the only thing worse is to think one knows what the disease is, only to discover, one is 180 degrees off course.

A thorough history and physical go a long way to postulating the correct first impression. There are a number of imaging techniques which are useful, but are intended for defining the illness, not for diagnosing it. CT scan, CT scan with contrast, MR, MR with contrast, ultra sound and nuclear scanning all play some role, but when over used, are unnecessarily expensive.

Fine needle aspiration is finding increasing role in diagnosing cervical masses. The fine needle aspiration is typically made with a 25 or 22 gauge needle. Bleeding is rarely a problem. Tumor seeding is not an issue, and diagnostic yields reach as high as 90% for both infection and neoplasm.