Introduction
Chronic rhinosinusitis is a multifactorial condition, defined by symptoms lasting longer than 12 weeks. Symptoms include nasal blockage/congestion/obstruction, nasal discharge (anterior or posterior), facial pain or pressure, reduced sense of smell/taste and cough.
Predisposing factors include bacterial infection, allergy, physical obstruction, immune deficiency, cystic fibrosis and prolonged use of intranasal decongestants.
Patients with coexisting allergic rhinitis may also have symptoms such as sneezing, watery rhinorrhoea, nasal itching and itchy watery eyes.
When to refer
Periorbital cellulitis is a red flag for acute ethmoiditis and these children should be referred to the ED.
Periorbital cellulitis is characterized by periorbital swelling, fever, pain, reduced eye movement, proptosis and possible reduction in visual acuity-colour vision is first effected,
- The above measures have failed and symptoms have persisted for greater than 3 months
- Unilateral symptoms
- Obstruction without other symptoms
- Address predisposing factors including allergen avoidance
- Consider oral antihistamine if suspect allergy
- Intranasal steroids for a minimum of 6-8 weeks
- Regular nasal douching with saline solutions (e.g. Sterimar spray, Neilmed Sinus Rinse)
- Treat eye symptoms if present (Sodium chromoglygate)
- CT scans and plain X-rays should NOT be performed
