Acute Sinusitis
Acute Sinusitis Red Flags - Immediate referral for the following
Periorbital oedema/ erythema
Displaced globe
Double vision
Ophthalmoplegia
Reduced visual acuity
Severe headache (uni/bilateral)
Frontal swelling
Signs of meningitis
Neurological signs
Acute Rhinosinusitis - Diagnosis
Continuous symptoms for less than 12 weeks:
Sudden onset of two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge:
+/- facial pain/pressure
+/- reduction/loss of smell
+/- cough
Examination: anterior rhinoscopy: swelling, redness, pus, exclude dental infection
Community treatment prior to referral:
In those patients with post-viral rhinosinusitis (ie symptoms persistent after 10 days or increasing after 5 days):
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Topical treatment as per treatment ladder found here
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Complete a full course of optimal topical treatment prior to referral.
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If symptoms include the following, then a bacterial cause may be more likely. Please treat according to NICE Guidance (click here)
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Symptoms for more than 10 days
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Discoloured or purulent nasal discharge
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Severe localised unilateral pain (particularly pain over teeth and jaw)
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Fever
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Marked deterioration after an initial milder phase
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When to consider referral
Red flag symptoms
Increasingly severe symptoms despite optimal community treatment
Recurrent acute rhinosinusitis (resolution between bouts), with four or more bouts per year.
Primary care investigations prior to referral
XRay/CT – not recommended
References
European Position Paper on Rhinosinusitus and Nasal Polyps 2012 - click here to view
NICE Guideline 79. Sinusitis (acute): antimicrobial prescribing. Oct 2017 - click here to view