ADULT CHRONIC NASAL BLOCKAGE REFERRAL FORM
PATIENT DETAILS:
Patient Name:
Address:
NHS No:
Hospital No:
Date of Birth:
Phone No:
Post code:
GP DETAILS:
GP Name:
Address:
GP Code:
Post Code:
Fax No:
PHONE No:
Interpreter required: Yes/ No
Age:
Sex:
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PRE REFERRAL MANAGEMENT
RHINITIS: symptoms include bilateral or alternating blockage, +/- clear discharge, +/- sneezing, but
without discomfort or hyposmia.
Start with a trial of intranasal steroids eg. Fluticasone or Mometasone, for a minimum of 6 weeks,
which must be taken regularly.
If allergy test positive: topical antihistamines eg Azelastine.
CHRONIC SINUSITIS: suspect if the symptoms include discomfort/ pain or hyposmia or yellow
discharge, particularly if the symptoms started after an URTI. Definitive diagnosis is made by rigid
endoscopy in ENT clinic, looking at the maxillary ostium. However, with a classical history, intensive
medical treatment should be attempted before referral with Betnesol at 2 drops BD to both nostrils for
up to 6 weeks if severe (in the head down- and- forward position- see diagram), in combination with
Augmentin or Doxycycline for the first two weeks of the course. If no response after 6 weeks of good
compliance with treatment, Refer to In Health for CT sinus - ENT clinic may consider FESS.
DEVIATED SEPTUM: not all deviated septums need surgery: could the blockage be due to rhinitis or sinusitis? If so
treat. (Particularly if the patient’s feeling of blockage and the narrowing caused by the septal deviation are not on the
same side).
HISTORY AND EXAMINATION
Past medical/ surgical History: (including drug treatment and allergies)
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Blockage:
Unilateral
Bilateral
Alternate sides
Discharge:
Clear, Yellow, or green (please circle)
Blood stained
Hyposmia:
Smell affected
Ethmoidal discomfort:(bridge of nose)
Sneezing
Patient presently taking topical vasoconstrictors
Has the patient complied with the treatment above
CT of sinus
Yes
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No
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.pots os fi ‫ٱ‬
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EXAMINATION: (If you think you can see a polyp on one side but not the other, check it’s not a turbinate by touching it with an
instrument. If the patient can feel the instrument, the lump is not a polyp!
GP signature:
Name:
Practice:
Date:
CHRONIC SINUSITIS
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Suspect if the symptoms include discomfort/pain or hyposmia or yellow discharge,
particularly if the symptoms started after an URTI.
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The definitive diagnosis is made in the ENT clinic by rigid endoscopy, to look at the
maxillary ostium, but with a classical history, intensive medical treatment should be tried
before referral - Betnesol – 2 drops to both nostrils for up to 6 weeks if severe, (as in the
picture) combined with Augmentin, doxycycline for the first 2 weeks of the course.
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CT of sinus available by referral to In Health
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In the ENT clinic, FESS will be considered for chronic sinusitis not responding to medical
treatment as outlined above (if a full 6 weeks of Betnesol treatment has been complied
with) or for recurrent acute sinusitis at an unacceptable frequency despite correct
treatment. Plain sinus Xrays are rarely used now, or are washouts often done.
POLYPS
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Unilateral polyps require urgent histology, but if referring urgently, beware confusion with
a large turbinate! Patients can feel a turbinate being touched with, eg, a long probe, but
polyps are asensate.
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Fluticosone or nasonex may help if symtoms are mild, and even with large bi-lateral
polyps betnesol (for not more than 6 weeks) may well help. If symptoms are
unacceptable to the patient despite the above medical treatment, refer for either
intranasal polypectomy, or sometimes, FESS.
POSTNASAL SPACE CARCINOMA
Beware if recent onset nasal symptoms, especially blockage, bleeding or pain.
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Is the patient Chinese?
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Does the patient have adult glue ear?
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Does the patient have recent headache?
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Is there a neck lump?
NASAL OBSTRUCTION IN CHILDREN
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Adenoids are not the only cause of blocked noses in children. Children can have rhinitis,
just like adults, and can have synthetic steroids eg fluticasone, if old enough (fluticasone
is licensed to 4), or topical antihistamines.
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Sinusitus presents atypically in children – some children with chronic yellow or green
nasal discharge have sinusitis, without a major complaint of pain or discomfort. Treat with
antibiotics and topical steroids, but beware betnesol in children.
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Unilateral nasal discharge is due to a foreign body unless proven otherwise.
Adenoidectomy may be considered where medical treatment has failed, particularly when the
nasal obstruction is so severe as to prevent the child eating comfortably or getting a good
nights sleep. (True sleep apnoe warants an adenotonsillectomy rather than adenoidectomy
alone.)