Rhinosinusitis Referral Access Criteria

• Visual disturbance, epistaxis, neurological signs, frontal swelling, severe unilateral or bilateral headache
• Eye pain, swelling or abnormal eye movement
• Orbital cellulitis         

• Nil

Recurrent acute rhinosinusitis

• Episodes must be well documented, clinically significant and adequately treated as per best practice guidelines for primary care including the regular use of intranasal irrigation and intranasal steroids and frequency:
  
  • ≥4 episodes per year or
  • ≥2 episodes per year over 3 years

Chronic Rhinosinusitis

• At least 3 months history of inflammation of the nose and the paranasal sinuses that persist for > 4 weeks despite medical treatment (for example broad spectrum antibiotics, oral steroids, nasal steroids and/or irrigation) and
• Symptoms must include:
  
  • Nasal blockage, obstruction or congestion, or
  • Purulent nasal discharge (anterior or posterior nasal drip), and one or more of the following:
    
    • facial pain/pressure
    • reduction or loss of smell
    • nasal polyps
  • And an abnormal CT scan consistent with sinus disease despite appropriate treatment (generally should be performed after a 4 week course of broad-spectrum antibiotics)

Allergic Rhinitis

• If unresponsive to best practice primary care only if there is an associated physical deformity, for example a deviated septum (allergic rhinitis, without associated physical deformity, requiring specialist review should be referred to Immunology)

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Relevant history, onset, duration, frequency and severity of episodes
• Whether the patient has acute or chronic rhinosinusitis
• Details of previous treatment and outcome including details/duration of:
  
  • antibiotic use,
  • nasal steroids or irrigation,
  • antihistamines and
  • ENT surgical history

• Appearance of nasal passages and throat including presence or absence of polyps

• Nil

• Nil

• Nil

• Nil            

Category 1

Appointment within 30 days           

• No defined category 1 criteria 

Category 2

Appointment within 90 days

• Complicated sinus disease (extra-sinus extension, suggestive of fungal disease)

Category 3

Appointment within 365 days

• Chronic and recurrent: persistent > 8 weeks, and /or > 3 episodes per year
• Failed/not responding to maximal medical management

• Mild acute rhinosinusitis:
  • Patients with headaches who have a normal CT scan which has been performed when the patient has symptoms.
  • Patients who have not had three months of intranasal steroid and nasal lavage treatment.

• See Clinician Assist WA: Rhinosinusitis (external site)