Acute sinusitis

Scope

This guidance covers sinusitis of less than 3 months duration. Usually follows viral upper respiratory tract infection (URTI).

Out of scope

Sinusitis of more than 3 months duration - see Rhinitis/Sinusitis/Nasal Polyps

Assessment

Signs and Symptoms

Symptoms include:

  • Blocked nose
  • Nasal discharge or post nasal drip
  • Reduced sense of smell or taste
  • Facial pain (facial pain in the absence of nasal symptoms is unlikely to be due to sinusitis)

Differential Diagnoses

  • Allergic rhinitis
  • Dental abscess with sinus involvement

Red Flags

If patient presents with bloody discharge or progressive unilateral symptoms a 2ww referral should be made directly to ENT.

If suspicion of orbital or intracranial complications same day urgent referral to ENT.

Patients with a swollen red eye and acute sinusitis maybe suffering from orbital infection should be admitted immediately.

Investigations

Plain sinus x ray not indicated.

Management

Realistic expectation of symptom duration: 14-21 days is normal for acute sinusitis.

Initial management supportive:

Persistent (more than 5 days) or severely or rapidly deteriorating symptoms:

Non resolution in 14 days consider:

  • Change antibiotic and cover beta lactamase producing and anaerobic organisms

Formulary Chapter 12.2 Nose

Referral

Referral Criteria

Refer to ENT if
  • Failure of uncomplicated acute sinusitis to respond to above treatment within 4-6 weeks
  • Acute sinusitis with complications discuss with on-call ENT surgeon via switchboard including periorbital cellulitis

Referral Instructions

Information to include in referral
  • History and treatment as per guidance
  • Any significant dental history if known

e-Referrals Service Selection

  • Specialty: Ear, Nose & Throat
  • Clinic Type: Nose/Sinus
  • Service: DRSS-South Devon & Torbay-Ear Nose and Throat- Devon CCG -15N

Referral Forms

DRSS referral form

Torbay and South Devon seeking advice form

Supporting Information

Evidence

NICE guideline 69

EPOS primary care guidelines Thomas et.al 2008

Pathway Group

This guideline has been signed off by South Devon and Torbay CCG

Publication date: October 2017

 

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