Referral criteria from primary care - sinusitis

Red flag signs in acute rhinosinusitis warranting urgent ENT referral include:

• frontal swelling
• severe frontal headache (worse than patient has experienced before)
• neurological signs
• signs of meningitis on clinical examination
• reduced level of consciousness
• reduced visual acuity
• double vision (diplopia)
• periorbital oedema/erythema (cellulitis)
• displaced globe
• opthalmoplegia.

Reference:

1. Foden N, Burgess C, Shepherd K, Almeyda R. A guide to the management of acute rhinosinusitis in primary care management strategy based on best evidence and recent European guidelines. The British Journal of General Practice. 2013;63(616):611-613.
2. Rosenfeld RM et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-S39