What criteria should I use to refer a patient with chronic rhinosinusitis for specialist evaluation?

Referral criteria for chronic rhinosinusitis to specialist evaluation:

Patients with chronic rhinosinusitis should be referred for specialist evaluation if they have persistent symptoms despite appropriate medical treatment, or if there are complications or atypical features suggesting a more serious underlying condition. Referral is particularly indicated when symptoms significantly impact quality of life or when there is suspicion of an alternative diagnosis such as neoplasia.

Although the provided guideline excerpts do not explicitly detail chronic rhinosinusitis referral criteria, standard UK practice based on NICE and ENT guidelines recommends referral when:

• Symptoms persist beyond 12 weeks despite medical management including nasal corticosteroids and appropriate antibiotics if indicated.
• There is evidence of complications such as orbital cellulitis, abscess, or intracranial extension.
• There are atypical features such as unilateral symptoms, nasal polyps, or suspicion of malignancy.
• There is significant impact on daily functioning or failure to respond to initial treatment in primary care.

In summary, referral for specialist assessment is warranted for chronic rhinosinusitis patients with refractory symptoms, complications, or suspicion of alternative diagnoses.