Referral guideline – Chronic rhinosinusitis/nasal congestion

Introduction

Chronic rhinosinusitis is a multifactorial condition, defined by symptoms lasting longer than 12 weeks. Symptoms include nasal blockage/congestion/obstruction, nasal discharge (anterior or posterior), facial pain or pressure, reduced sense of smell/taste and cough.

Predisposing factors include bacterial infection, allergy, physical obstruction, immune deficiency, cystic fibrosis and prolonged use of intranasal decongestant sprays.

Patients with coexisting allergic rhinitis may also have symptoms such as sneezing, watery rhinorrhoea, nasal itching and itchy watery eyes.

GP management

  • Address predisposing factors including allergen avoidance
  • Intranasal steroids for a minimum of 6-8 weeks
    • The effect of intranasal steroids can be enhanced by using intranasal saline beforehand to loosen secretions, blowing the nose, then using the steroid spray
  • Consider oral antihistamines as second-line agents
  • CT scans or plain films should NOT be performed

Refer to Therapeutic Guidelines for more information.

When to refer

Refer for non-urgent excision (category 3) when:

  • the above measures have failed and symptoms have persisted for greater than 3 months
  • unilateral symptoms
  • obstruction without other symptoms.

Note: Periorbital cellulitis is a red flag for ethmoiditis and these children should be referred to the emergency department.

Essential referral info

  • Presenting complaint and reason for referral
  • Detailed history of symptoms including treatment to date and the response to this
  • Patient details (name, age and gender)
  • Medicare number
  • Parent/Carer’s name and contact details
  • Referring clinician details (name, contact details, provider number, date and length of referral)

From 1 May 2019 referral criteria will apply at CHQ. This condition has minimum demographic and essential clinical referral information that is required to be included prior to submission of the referral. Visit the CPC website for the required condition. If you are unable to provide the required “essential information” please state the reason when you submit the referral.

Helpful referral info

  • Other past medical and surgical history
  • Antenatal and perinatal history that may be relevant – prematurity, birth weight, birth trauma, or alcohol/drug use in pregnancy
  • Family history
  • Current medications and allergies
  • Immunisations
  • Examination findings – including any dysmorphic features, full ocular examination
  • Is the patient of Aboriginal or Torres Strait Islander descent?

Parent service

Otolaryngology Head and Neck Surgery

Contact details

Hospital Switchboard
(Ask for Otolaryngology (ENT) On-call Registrar)
t: 07 3068 1111