What are the indications for referring a patient with rhinitis to an ENT specialist?

Refer a patient with rhinitis to an ear, nose, and throat (ENT) specialist if any of the following indications are present:

• Symptoms persist despite compliance with 6 to 12 weeks of treatment.
• The patient is immunocompromised.
• Symptoms significantly affect quality of life.
• There is a suspected allergic or immunological cause complicating management.
• An anatomical defect is causing nasal obstruction.
• There is a comorbidity complicating management, such as nasal polyps or asthma.
• There is suspicion of adenoid hypertrophy.
• There is doubt about the diagnosis.
• Presence of cacosmia (a foul smell sensation) requires immediate referral.
• Symptoms suggest neoplasm, such as persistent unilateral nasal obstruction, discharge, nosebleeds, crusting, or facial swelling, warrant urgent suspected cancer pathway referral.

Referral urgency depends on clinical judgement and severity of symptoms.