What are the guidelines for discharging an Ear, Nose, and Throat (ENT) patient from clinical follow-up in various cases?

From the Guidelines

As an ENT doctor, you can discharge patients from clinic follow-up based on specific criteria for various conditions, prioritizing those with low risk of recurrence and complications, as outlined in the most recent guidelines from 2020 1.

Discharge Criteria for Various Conditions

• For patients with squamous cell carcinoma of the oral cavity, larynx, oropharynx, and hypopharynx, discharge after 5 years of annual follow-up, as the risk of disease relapse decreases significantly after this period 1.
• For patients with locally advanced disease, discharge after 2-3 years of close follow-up, including head and neck examination by flexible endoscopy every 2-3 months, and annually thereafter 1.
• For patients treated with RT, discharge after 1-2 years of follow-up, including daily dental evaluation every 6 months and yearly TSH dosage, as well as tobacco and alcohol withdrawal counseling and psychological support as clinically indicated 1.

Key Considerations for Discharge

• The risk of disease relapse is estimated at between 40% and 60% for patients with locally advanced disease, with most recurrences occurring within the first 2 years after the primary diagnosis 1.
• The incidence of second primaries is 2%–4% per year and remains relatively constant over time 1.
• Prevention and screening for other cancers sharing the same risk factors should be carried out according to their respective guidelines 1.

Follow-up Schedule

• Clinical follow-up, including a head and neck examination by flexible endoscopy, should be carried out every 2–3 months during the first 2 years, every 6 months for years 3–5 and annually thereafter 1.
• Head and neck imaging is recommended 3 months after the primary treatment to assess the patient status and to have a baseline post-treatment imaging assessment 1.
• FDG-PET/CT is recommended 3 months after CRT for patients with node-positive disease to assess the necessity of neck dissection 1.

From the Research

Discharge Guidelines for ENT Patients

The decision to discharge an ENT patient from clinic follow-up depends on various factors, including the nature of the condition, its long-term management, and patient satisfaction. The following are some guidelines for discharge based on existing studies:

• Patient satisfaction and general practitioner management: A study published in 1994 2 found that the majority of patients and general practitioners are happy for ongoing medical care to be continued without further ENT appointments if the nature of the condition and its long-term management is explained clearly. This suggests that patients can be safely discharged from clinic follow-up if their condition is stable and they are satisfied with their care.
• Ambulatory management of common ENT emergencies: A 2021 review 3 found that out-patient and ambulatory pathways for tonsillitis, peritonsillar abscess, and epistaxis are well described for patients meeting appropriate criteria. This suggests that select patients with these conditions can be safely managed out of hospital, with low re-admission rates.
• Coexisting conditions: A 1986 study 4 highlighted the importance of diagnosing coexisting conditions, such as otosclerosis and Meniere's disease. This suggests that patients with complex conditions may require ongoing ENT follow-up to ensure effective management.

Specific Conditions

The following are some specific conditions where discharge from clinic follow-up may be considered:

• Tonsillitis: Patients with tonsillitis can be safely managed out of hospital if they meet appropriate criteria, such as controlled symptoms and no signs of complications 3.
• Peritonsillar abscess: Patients with peritonsillar abscess can be safely managed out of hospital if they meet appropriate criteria, such as controlled symptoms and no signs of complications 3.
• Epistaxis: Patients with epistaxis can be safely discharged if their bleeding is controlled 3.
• Otosclerosis and Meniere's disease: Patients with coexisting otosclerosis and Meniere's disease may require ongoing ENT follow-up to ensure effective management 4.