Acute Sinusitis

Acute Sinusitis Red Flags - Immediate referral for the following

Periorbital oedema/ erythema

Displaced globe

Double vision


Reduced visual acuity

Severe headache (uni/bilateral)

Frontal swelling

Signs of meningitis

Neurological signs


Acute Rhinosinusitis - Diagnosis

Continuous symptoms for less than 12 weeks:

Sudden onset of two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge:

+/- facial pain/pressure

+/- reduction/loss of smell

+/- cough

Examination: anterior rhinoscopy: swelling, redness, pus, exclude dental infection


Community treatment prior to referral:

In those patients with post-viral rhinosinusitis (ie symptoms persistent after 10 days or increasing after 5 days):

  • Topical treatment as per treatment ladder found here

  • Complete a full course of optimal topical treatment prior to referral.

  • If symptoms include the following, then a bacterial cause may be more likely. Please treat according to NICE Guidance (click here)

    • Symptoms for more than 10 days

    • Discoloured or purulent nasal discharge

    • Severe localised unilateral pain (particularly pain over teeth and jaw)

    • Fever

    • Marked deterioration after an initial milder phase



When to consider referral

Red flag symptoms

Increasingly severe symptoms despite optimal community treatment

Recurrent acute rhinosinusitis (resolution between bouts), with four or more bouts per year.


Primary care investigations prior to referral

XRay/CT – not recommended


European Position Paper on Rhinosinusitus and Nasal Polyps 2012 - click here to view

NICE Guideline 79. Sinusitis (acute): antimicrobial prescribing. Oct 2017 - click here to view