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.

Plain sinus x ray not indicate.

Initial management supportive:

• Paracetamol
• Inhalation steam
• Decongestion as per formulary 12.2 Nose

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

In addition to above

• Topical nasal steroids
• Broad spectrum antibiotic as per formulary

Non resolution in 14 days consider:

• Change antibiotic and cover beta lactamase producing and anaerobic organisms

Referral Criteria

Refer to ENT if:

• Severe symptoms
• Failure of second line treatment
• Recurrent episodes develop

Referral Instructions

Information to include in referral:

• History and treatment as per guidance
• Any significant dental history if known

e-Referral Selection

• • Specialty: Ear, Nose & Throat
  • Clinic Type: Nose/Sinus
  • Service: DRSS-Western-ENT- Devon ICB-15N

Referral Form

DRSS referral form

Evidence

NICE guideline 69 - Respiratory tract infections (self-limiting) prescribing antibiotics

EPOS Primary Care Guidelines -Thomas et.al 2008

Pathway Group

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

Publication date: March 2016