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Referral criteria from primary care - sinusitis

Authoring team

Red flag signs in acute rhinosinusitis warranting urgent ENT referral include:

  • frontal swelling
  • severe frontal headache (worse than patient has experienced before)
  • neurological signs
  • signs of meningitis on clinical examination
  • reduced level of consciousness
  • reduced visual acuity
  • double vision (diplopia)
  • periorbital oedema/erythema (cellulitis)
  • displaced globe
  • ophthalmoplegia.

Reference:

  1. Keating MK, Phillips JC, Phillips J. Chronic rhinosinusitis. Am Fam Physician. 2023 Oct;108(4):370-7.
  2. Payne SC, McKenna M, Buckley J, et al. Clinical practice guideline: adult sinusitis update. Otolaryngol Head Neck Surg. 2025 Aug;173(suppl 1):S1-56.

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