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.

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

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.

Investigations

Plain sinus x ray not indicate.

Management

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

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-NEW Devon CCG- 99P

Referral Forms

DRSS referral form

Supporting Information

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 by the Western Locality on behalf of NEW Devon CCG.

Publication date: March 2016

 

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