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Rhinosinusitis (chronic/recurrent)

Emergency department referrals

All urgent cases must be discussed with the on call ENT Registrar. Contact through Royal Brisbane and Women's Hospital (07) 3646 8111 to obtain appropriate prioritisation and treatment.

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary):

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

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • No category 1 criteria

Category 2

Appointment within 90 days is desirable

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

Category 3

Appointment within 365 days is desirable

  • Chronic and recurrent: persistent symptoms > 8 weeks, and/or > 3 episodes per year
  • Failed/not responding to maximal medical management (where available and not cause significant delay)

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Refer to HealthPathways for assessment and management information if available

Medical management

  • Treat any acute bacterial infection appropriately
  • 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)

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • 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)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • 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

  • 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

  • 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

  • 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

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

  • 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.)
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