We aim at implementing ultrasound examination performed by the ear, nose and throat (ENT) specialist as the central diagnostic tool in the management of cases with head and neck masses. We present a series of 97 cases with head and neck masses that benefited from the use of ultrasonography performed first hand by the ENT specialist in order to differentiate benign from malignant lesions. All cases that underwent surgical treatment had the initial ultrasonographic diagnosis cross referenced with the pathology result. We underline those cases where the ultrasound exam changed the diagnosis between benign and malignant lesions. Ultrasonography exam is cost-effective and improves the adhesion of the patient to the treatment. The main advantages of ultrasonographic imaging are lack of irradiation and the possibility to repeatedly examine a lesion in order to ascertain its response to treatment. Sonography prevented misdiagnosing the neck mass and the optimum management was installed earlier.