Acute sinusitis


This guidance covers sinusitis of less than 3 months duration. Usually follows viral upper respiratory tract infection (URTI).

Out of scope

Sinusitis of more than 3 months duration - see referral guideline Chronic rhinosinusitis with or without polyps


Signs and Symptoms

Symptoms include:

  • Blocked nose
  • Nasal discharge or post nasal drip
  • Reduced sense of smell or taste
  • Facial pain (facial pain in the absence of nasal symptoms is unlikely to be due to sinusitis)

Differential Diagnoses

Red Flags

If patient presents with bloody discharge or progressive unilateral symptoms a 2ww referral should be made directly to ENT.

If suspicion of orbital or intracranial complications same day urgent referral to ENT.

Patients with a swollen red eye and acute sinusitis maybe suffering from orbital infection should be admitted immediately.


Plain sinus x ray not indicated.


Realistic expectation of symptom duration: 14-21 days is normal for acute sinusitis.

Initial management supportive:

Persistent (more than 5 days) or severely or rapidly deteriorating symptoms:

Non resolution in 14 days consider:

  • Change antibiotic and cover beta lactamase producing and anaerobic organisms

Formulary Chapter 12.2 Nose


Referral Criteria

Refer to ENT if
  • Failure of uncomplicated acute sinusitis to respond to above treatment within 4-6 weeks
  • Acute sinusitis with complications discuss with on-call ENT surgeon via switchboard

Referral Instructions

Information to include in referral
  • History and treatment as per guidance
  • Any significant dental history if known

e-Referrals Service Selection

  • Specialty: Ear, Nose & Throat
  • Clinic Type: Nose/Sinus
  • Service: DRSS-Eastern-Ear Nose and Throat-Devon CCG- 15N

Referral Forms

DRSS Referral forms

Supporting Information


NICE guideline 69

EPOS primary care guidelines Thomas 2008

Pathway Group

This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.

Publication date: 02 December 2016


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