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

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 ¹.

• Referral should be considered if symptoms are recurrent or significantly affect the patient's quality of life ¹.
• Refer if there is no improvement in 6–12 weeks, or if symptoms persist despite compliance with 3 months of treatment ¹.
• An immediate referral is indicated if the patient experiences cacosmia (a distorted sense of smell) ¹.
• Other reasons for referral include if the person is immunocompromised ¹.
• Referral is also appropriate if there is a suspected allergic or immunological cause ¹.
• Consider referral if an anatomic defect is causing obstruction ¹.
• If there is a comorbidity complicating management, such as nasal polyps or asthma, referral may be needed ¹.
• Refer if the sinusitis is associated with an unusual or resistant bacteria ¹.
• For a child, recurrent episodes of otitis media and pneumonia can indicate a need for referral ¹.
• Suspicion of adenoid hypertrophy also warrants referral ¹.
• Finally, if there is doubt about the diagnosis, specialist advice should be sought ¹.