REMEDY : BNSSG referral pathways

Nasal Treatment

Checked: 24-01-2017 by christopher.moloney Next Review: 21-12-2018

Principles of Management

Nasal Polyps and Chronic Rhinosinusitis

There are local Guidelines on diagnosis and management of nasal polyps and chronic rhinosinusitis in primary care. These guidelines were developed between the ENT leads of inner city and east practices on 4th November 2013. The team reviewed current guidelines and discussed controversial points. Prior to the meeting and also sought the advice of Paul Tierney a local ENT consultant. 

Please also refer to the BNSSG Joint Formulary for the latest prescribing guidance

There are Clinical Knowledge Summary guidelines on management of Sinusitis

Referral Guidance

Referral for cosmetic surgery to the nose is not  funded on the NHS as stated in the Cosmetic Surgery IFR policy

Referral to secondary care ENT for other non- cosmetic nasal treatments are now also subject to an INNF Nasal Treatment policy and prior approval is required before referrals can be submitted.

If  malignancy needs to be excluded then a 2WW referral should be make (see red flag section below).

Red Flags

Please see Head and Neck 2WW guidelines.

Refer all patients with unilateral nasal obstruction with bloody discharge via 2WW pathway.

Consider 2WW referral or discussion with ENT in patients with nasal symptoms and any of the following:

  •     Unilateral symptoms

  •  Bleeding

  •  Crusting

  •      Cacosmia (foul odour when none exists)

  •      Orbital/visual symptoms: displaced globe, double vision, ophthalmoplegia, reduced visual acuity

  •  Severe unilateral or bilateral frontal headache

  •  Frontal swelling

  •  Signs of meningitis

  •      Neurological signs

(if no tick box on 2WW then free text your concerns)

Nasal Fracture

Patients who have sustained a nasal injury/ fracture within the last 2 weeks can be offered an ENT hot clinic appointment. To access this clinic please phone the on-call ENT at St Michaels Hospital via UHB switch (GP direct line is 921 4858). This would be the correct referral route for immediate post trauma fractures.

If more than 2 weeks have passed since the injury then it may be too late for this service. Any further consideration of nasal surgery or treatment would then be subject to the policies above.