Rhinosinusitis – Paediatric

Referrers should use this page when referring patients to public paediatric ENT outpatient services for rhinosinusitis. This RAC is applicable to referrals for patients aged <16 years only. Please refer to the ENT (Adult) RAC for referrals for patients aged 16 years or more.

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

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

Immediately contact on-call registrar or service to arrange an immediate ENT assessment (seen within 7 days) for:

  • Nil

To contact the relevant service, please see HealthPathways: Acute Paediatric ENT Assessment

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Visual disturbance, epistaxis, neurological signs, frontal swelling, severe unilateral or bilateral headache
  • Eye pain, swelling or abnormal eye movement
  • Orbital cellulitis         
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate paediatric ENT assessment (seen within 7 days):
  • Nil
To contact the relevant service, see HealthPathways: Acute Paediatric ENT assessment (external site)
Presenting issues
 If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).

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)
     
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test due to financial reasons or geographical location).

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.

History
  • 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
Examination
  • Appearance of nasal passages and throat including presence or absence of polyps
Investigations
  • Nil
Highly desirable
History
  • Nil
Examination
  • Nil
Investigations
  • Nil            
Indicative triage category

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
     
Exclusions
  • 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.

Useful information
Indicative triage category
Indicative triage category
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
Excluded ENT services

Referral to public paediatric ENT outpatient services is not routinely accepted for the following conditions:

Condition Details (where applicable)
Mild acute rhinosinusitis

Excluded condition when the following features apply:

  • 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
Last reviewed: 04-10-2023