Rhinosinusitis

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

Acute bacterial sinusitis deteriorating despite medical treatment – visual disturbance/signs, neurological signs, frontal swelling/severe unilateral or bilateral headache, eye pain, swelling or abnormal eye movement
Unilateral facial swelling with or without dental sepsis
Orbital cellulitis

Immediately contact on-call registrar or service to arrange an immediate ENT assessment (seen within 7 days) for:

To contact the relevant service, please see HealthPathways: Acute ENT Assessment

Presenting issues
Recurrent Acute Rhinosinusitis Episodes must be well documented, clinically significant and adequately treated as per best practice guidelines for primary care including the regular use of intranasal irrigation and intranasal steroids and: Frequency: ≥4 episodes per year or ≥2 episodes per year over 3 years Chronic Rhinosinusitis At least 3 months history of inflammation of the nose and the paranasal sinuses that persist for >4 weeks despite medical treatment (e.g. broad spectrum antibiotics, oral steroids, nasal steroids and/or irrigation) and Symptoms must include either: Nasal blockage, obstruction or congestion, or Purulent nasal discharge (anterior or posterior nasal drip), and one or more of the following: Facial pain/pressure Reduction or loss of smell Nasal polyps Abnormal CT scan consistent with sinus disease despite appropriate treatment (generally should be performed after a four-week course of broad spectrum antibiotics) Allergic rhinitis Allergic rhinitis unresponsive to best practice primary care only if there is an associated physical deformity, for example a deviated septum (generally allergic rhinitis requiring specialist review should be referred to Immunology).

Presenting issues

Recurrent Acute Rhinosinusitis

Episodes must be well documented, clinically significant and adequately treated as per best practice guidelines for primary care including the regular use of intranasal irrigation and intranasal steroids and:
Frequency:
- ≥4 episodes per year or
- ≥2 episodes per year over 3 years

Chronic Rhinosinusitis

At least 3 months history of inflammation of the nose and the paranasal sinuses that persist for >4 weeks despite medical treatment (e.g. broad spectrum antibiotics, oral steroids, nasal steroids and/or irrigation) and
Symptoms must include either:
- Nasal blockage, obstruction or congestion, or
- Purulent nasal discharge (anterior or posterior nasal drip), and one or more of the following:
  - Facial pain/pressure
  - Reduction or loss of smell
  - Nasal polyps
Abnormal CT scan consistent with sinus disease despite appropriate treatment (generally should be performed after a four-week course of broad spectrum antibiotics)

Allergic rhinitis

Allergic rhinitis unresponsive to best practice primary care only if there is an associated physical deformity, for example a deviated septum (generally allergic rhinitis requiring specialist review should be referred to Immunology).

Mandatory referral information (referral will be returned if this information is not included)
History Relevant history, onset, duration, frequency and severity of symptoms including if acute or chronic rhinosinusitis Details of previous treatment and outcome including: Previous antibiotics use Previous nasal steroids or irrigation Previous antihistamines Previous ENT surgical history Examination Appearance of nasal passages and throat including presence or absence of polyps Investigations CT scan of sinuses (provider and date of scan) where available and providing it will not cause significant delay (not required for allergic rhinitis) If unable to attach reports, please include relevant information/findings in the body of the referral Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access due to geographical location or financial cost)

Mandatory referral information (referral will be returned if this information is not included)

History

Relevant history, onset, duration, frequency and severity of symptoms including if acute or chronic rhinosinusitis
Details of previous treatment and outcome including:
- Previous antibiotics use
- Previous nasal steroids or irrigation
- Previous antihistamines
Previous ENT surgical history

Examination

Appearance of nasal passages and throat including presence or absence of polyps

Investigations

CT scan of sinuses (provider and date of scan) where available and providing it will not cause significant delay (not required for allergic rhinitis)

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access due to geographical location or financial cost)

Highly desirable referral information
Nil

Indicative triage category

Indicative triage category
Category 1 Appointment within 30 days	Suspected malignancy (radiology suspicion of tumour)
Category 2 Appointment within 90 days	Complicated sinus disease (extra-sinus extension, suggestive of fungal disease)
Category 3 Appointment within 365 days	Chronic and recurrent sinusitis according to description above Failed/not responding to maximal medical management Chronic nasal obstruction – in the setting of a deviated septum, turbinate hypertrophy, and/or nasal polyps

Excluded ENT services

Referral to public adult ENT outpatient services is not routinely accepted for the following conditions:

Condition	Details
Mild acute rhinosinusitis	Patients with headaches who have a normal CT scan which has been performed when the patient has symptoms Patients who have not had three months of intranasal steroid and nasal lavage treatment See HealthPathways: Rhinosinusitis

Last reviewed: 02-10-2023

Rhinosinusitis

Referral to public adult ENT outpatient services is not routinely accepted for the following conditions:

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