Background: The SARS-CoV-2 was first reported in December 2019 in Wuhan, China and has been declared a pandemic in March 2020. COVID-19 has caused unprecedented and lasting biopsychosocial effects worldwide. All healthcare professionals have faced life threatening risks by attending their daily jobs. The daily emergence of advice and guidelines was necessary to ensure the safety of patients and staff. To this effect, all elective services came to a halt to preserve hospitals’ capacity for dealing with the sickest. This retrospective, descriptive review aims to assess the volume and timing of the advice released specifically relevant to the UK Otolaryngologist. Methods: The search included online advice published in English by international, national and ENT-specific organisations between the 1st of January to the 31st of May. The date, title, source, type of advice and link to the advice was recorded in Excel. The resources were analysed per week of publication. A separate search for peer-reviewed publications was conducted using PubMed Central and Cochrane databases. Findings: 175 covid-19 related guidance’s were identified. 52/175 (29.7%) articles were published by international organisations. 56/175 (32%) were produced by national organisations and 67/175 (38.28%) were produced by ENT specific organisations. The peak guidance production took place in the third and fourth week of March (16/03/2020- 29/03/2020) with 72/175 publications. Of these, 27/72 came from the international category, 17/72 from national bodies and 28/72 from ENT-specific organisations. 13,863 total publications relating to COVID-19 were found using PubMed and Cochrane search strategies; 76% were relevant to ENT surgeons. Conclusion: The challenges faced by the Otolaryngologist relate to the unprecedented, sudden and daily changes to clinical practice. Multiple bodies interpreted the guidance giving an opportunity for confusion and delays in treatments for patients. Implementing a system with clear lines of communication and dissemination of information will improve our response in future pandemic events whilst maintaining a commercial awareness to better use the human and financial resources of an already financially-restricted NHS.

Objectives The objectives of this study are to describe the incidence and age range of presentation of lateral neck cysts, to evaluate a management algorithm for adults presenting with lateral neck cystic lesions and to report the age incidence at which malignant cystic lesions in the neck have clinically presented as lateral neck cysts. Design A retrospective review of histologically diagnosed branchial cysts between 1995 and 2014 at a single centre. Setting Oxford University Hospitals NHS Foundation Trust. Participants A single senior head and neck pathologist and the ENT head and neck team. Main outcome measures Does a dedicated pathway help to identify malignancy in lateral neck cysts earlier in the diagnostic pathway? Results When using a random investigative pathway the sensitivity in distinguishing malignant from non-malignant was 93%, specificity 12% with a PPV of 83% and NPV 28%. When using a defined investigative protocol, the sensitivity was 94%, specificity 67%, PPV of 85% and NPV 86%. Conclusions This study conveys that using a structed pathway when working up patients with a lateral neck cyst results in a greater sensitivity, specificity, PPV and NPV in distinguishing malignancy compared to an unstructured workup. Key points 1) Establishing a lateral neck cyst as a benign structure is a diagnosis of exclusion 2) There is no established protocol for this pathway. 3) The need for a diagnostic pathway is important given the impact of COVID-19 4) The diagnostic challenge is differentiating benign from malignant 5) For lateral neck cysts a cut off age of 35 may not be appropriate