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Chronic Sinusitis/Polyposis

Chronic Sinusitis Red Flags – Click here

Chronic Rhinosinusitis (with or without Nasal Polyps) - Diagnosis

  • Symptoms of rhinosinusitis which persist for >12 weeks
  • Two or more symptoms one of which should be either nasal blockage/obstruction/congestion or nasal discharge:
    • ± facial pain/pressure,
    • ± reduction or loss of smell;
  • Examination: anterior rhinoscopy: swelling, redness, pus, exclude dental infection



  • If symptoms include the following, then a bacterial cause may be more likely.
    • Discoloured or purulent nasal discharge
    • Severe localised unilateral pain (particularly pain over teeth and jaw)
    • Fever
    • Marked deterioration after an initial milder phase

Treatment

  • Topical treatment as per treatment ladder found here.
  • Complete a full course of optimal topical treatment prior to referral.
  • If a bacterial cause is suspected then consider a 2 week course of appropriate antibiotic (as per up-to-date local formulary). Review the patient prior to completion of 2 week course and if there is improvement, consider continuing antibiotics to complete a total of 4 weeks.



When to consider referral

Increasingly severe symptoms despite optimal community treatment

Primary care investigations prior to referral

XR/ CT not recommended

References

European Position Paper on Rhinosinusitus and Nasal Polyps 2012-click here to view

ENT Advice and Guidance

Where patients fall outside of these referral criteria or there are questions with regard to community management, please utilise the ENT Advice and Guidance service - details here