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Rhinosinusitis%20-%20acute,%20bacterial%20(pediatric) Management
Specialist Referral
- Indications for specialist referral (eg infectious disease specialist, allergologist, or otorhinolaryngologist):
- Severe infection, signs of sepsis, signs of meningitis
- Severe headache, ophthalmologic abnormalities (periorbital edema/erythema, displaced globe, double vision, ophthalmoplegia, reduced visual acuity), frontal swelling, neurological signs
- Recalcitrant infection unresponsive to extended antibiotic therapy
- Immunocompromised patients with recurrent episodes of rhinosinusitis
- Presence of comorbidities that may affect treatment response
- Resistant pathogens
- Recurrent episodes (3-4x/year) suggesting chronicity of disease with accompanying exacerbations
- Evaluation of possible anatomical abnormalities causing obstruction that may need surgery
- Fungal sinus infection or granulomatous disease
- Nosocomial infection
- For evaluation of possible immunotherapy for patients with allergic rhinitis
- Otolaryngology consultation is recommended in moderately to severely ill patients suspected of acute frontal or sphenoid sinusitis because of possible intracranial spread and in patients who do not improve after adequate medical therapy
- Referral is also needed for possible maxillary sinus aspiration for culture and sensitivity so that therapy may be adjusted correctly
- Referral to an otolaryngologist and/or ophthalmologist is indicated when signs of impending suppurative complications are present
