Rhinosinusitis (chronic/recurrent)

ADULT
  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Acute bacterial rhinosinusitis – visual disturbance/signs, neurological signs/frontal swelling/severe unilateral or bilateral headache
    • Unilateral facial swelling with or without dental sepsis
  • Medical management

    • Treat any acute bacterial infection appropriately (10-day course of Augmentin duo forte)
    • 5 days only of BD nasal decongestant spray e.g. oxymetazoline at the start of the course
    • 3 months of:
      • oral roxithromycin 300mg daily
      • intra nasal steroid spray e.g. mometasone BD for 2 weeks, then nocte thereafter
      • intra nasal saline rinse/irrigation (not spray) BD-TDS
    • If rhinorrhoea is the predominant symptom add either ipratropium nasal spray or second-generation antihistamine
    • Consider short course of oral corticosteroid therapy
    • If symptoms persist at close of treatment, consider CT para nasal sinuses
    • Analgesia
    • Manage environmental factors:
      • co-existing allergies
      • discuss contribution of smoking
    • Discuss role of environmental and household pollutants (wood/coal smoke, incense, perfumes, chlorine)
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • No category 1 criteria
Category 2
(appointment within 90 calendar days)
  • Complicated sinus disease (extra-sinus extension, suggestive of fungal disease)
  • Oro-antral fistula
Category 3
(appointment within 365 calendar days)
  • Chronic and recurrent: persistent symptoms > 8 weeks, and/or > 3 episodes per year
  • Failed/not responding to maximal medical management

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Frequency of episodes
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • CT para nasal sinuses post full course of medical management (where available and not cause significant delay)

3. Additional referral information Useful for processing the referral

  • No additional information

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 15 January 2025

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