Rhinosinusitis


Indications for urgent referral

If patients present with:

  • visual disturbance, epistaxis, neurological signs, frontal swelling, severe unilateral or bilateral headache
  • eye pain, swelling or abnormal eye movement
  • orbital cellulitis.

For urgent referrals, contact the ENT Register at the relevant hospital.

Criteria for routine specialist referral via CRS

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:
    • four or more episodes per year or
    • two or more episodes per year over three years.

Chronic Rhinosinusitis

  • At least three months history of inflammation of the nose and the paranasal sinuses that persist for more than four weeks despite medical treatment (for example broad spectrum antibiotics, oral steroids, nasal steroids and/or irrigation) and
  • Symptoms must include:
    • 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.
  • An 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).

Routine referral information required

  • clinical history and examination considering:
    • specify acute or chronic rhinosinusitis
    • description of symptoms
    • duration, frequency and severity of episodes
    • appearance of nasal passages and throat including presence or absence of polyps
    • summary of treatment and response to date.
  • medical management to date (including details of nature and duration of)
  • previous antibiotics use
  • previous nasal steroids or irrigation
  • previous antihistamines
  • CT (sinus) report or state reason why not undertaken (not required for allergic rhinitis)
  • previous ENT surgical history.

Information about community management

Further information regarding primary care management of ENT conditions is available on the HealthPathways WA website. Please email the HealthPathways team to obtain the login details: healthpathways@wapha.org.au. HealthPathways are currently working on responding to the new criteria and will have all the ENT pathways adapted to WA as soon as possible.