How do I determine if a patient with recurrent sinusitis requires referral to an ENT specialist?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

A patient with recurrent sinusitis may require referral to an Ear, Nose, and Throat (ENT) specialist if certain criteria are met, with urgency depending on clinical judgement .

  • Referral should be considered if symptoms are recurrent or significantly affect the patient's quality of life .
  • Refer if there is no improvement in 6–12 weeks, or if symptoms persist despite compliance with 3 months of treatment .
  • An immediate referral is indicated if the patient experiences cacosmia (a distorted sense of smell) .
  • Other reasons for referral include if the person is immunocompromised .
  • Referral is also appropriate if there is a suspected allergic or immunological cause .
  • Consider referral if an anatomic defect is causing obstruction .
  • If there is a comorbidity complicating management, such as nasal polyps or asthma, referral may be needed .
  • Refer if the sinusitis is associated with an unusual or resistant bacteria .
  • For a child, recurrent episodes of otitis media and pneumonia can indicate a need for referral .
  • Suspicion of adenoid hypertrophy also warrants referral .
  • Finally, if there is doubt about the diagnosis, specialist advice should be sought .

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Educational content only. Always verify information and use clinical judgement.