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This guidance covers adults with nasal/sinus symptoms that have persisted for greater than 3 months.
Chronic rhinosinusitis (CRS) is defined as inflammation of the nasal sinuses that lasts longer than 12 weeks.
Many patients will respond to conservative treatment, thus avoiding not only a referral to secondary care, but also potentially an operation – see management section below.
There is a 'Chronic Rhinosinusitis Commissioning Policy' that accompanies this CRG.
Urgent referral via the 2-week Suspected Head and Neck Cancer pathway is required if there are:
There is no place for plain x rays of the sinuses or CT scans in primary care.
Many patients will respond to conservative treatment, thus avoiding not only a referral to secondary care, but, also, potentially an operation.
First line treatment in primary care should consist of:
Attention to smoking cessation and optimisation of asthma treatment if appropriate.
Patients should be advised to avoid allergic triggers and practise good dental hygiene to reduce the risk of dental infection (which can be associated with CRS).
BSACI guidelines for the management of rhinosinusitis and nasal polyposis
Referral for specialist assessment will only be funded when:
1. Patients have received a 3-month trial of intranasal steroids† and nasal saline irrigation AND have no improvement in symptoms of chronic rhinosinusitis (CRS) which is defined as:
Patients with bilateral nasal polyps should also have had no improvement in symptoms 4 weeks after a trial of 5-10 days of oral steroids†.
2. There is a concern regarding significant pathology that requires urgent ENT specialist opinion, but the patient does not have symptoms and signs that warrant a two week wait suspected cancer referral.
3. Patients have unilateral symptoms (persistent purulent discharge or nasal obstruction with epistaxis) or clinical findings (unilateral nasal mass or polyp), orbital or neurological features. These patients should be referred via the 2-week suspected Head and Neck cancer pathway.
† (unless contraindicated)
Information to include in referral
e-Referral Service Selection
European Position Paper on Rhinosinusitus and Nasal Polyps 2012
Sinusitis | Health topics A to Z | CKS | NICE (March 2021)
This guideline has been signed off on behalf of NHS Devon.
Publication date: July 2019
Updated: February 2023 in line with updated commissioning policy
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