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

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.

Plain sinus x ray not indicated.

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

Initial management supportive:

• Paracetamol
• Inhalation steam
• Decongestion as per formulary guidance

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

• In addition to above
  • Topical nasal steroids as per formulary guidance
  • Broad spectrum antibiotic as per formulary guidance

Non resolution in 14 days consider:

• Change antibiotic and cover beta lactamase producing and anaerobic organisms

Formulary Chapter 12.2 Nose

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 ICB -15N

Referral Forms

DRSS referral form

Torbay and South Devon seeking advice form

Evidence

NICE guideline 69

EPOS primary care guidelines Thomas et.al 2008

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: October 2017