1. Advice for Primary Care Referrers to ENT
Mr. Mark Draper

2. Nasal Blockage Initial Rx with ≥ 4/52 topical nasal steroid
Any patient on regular decongestants needs to stop for ≥ 2/52
Rx TNS e.g. Flixonase during this 2/52 period
(slightly reduces rebound effect)
Reassess. If still symptomatic consider GPwSI referral
If obvious DNS or severe external deformity – refer 2o care

3. Nasal Fracture Wait 5 days for swelling to subside slightly
If deviation and wants realignment, refer to 2o care via Emergency ENT clinic
(contact on-call SHO during office hours)

4. Nasal Fracture Wait 5 days for swelling to subside slightly
If deviation and wants realignment, refer to 2o care via Emergency ENT clinic
(contact on-call SHO during office hours)

5. Rhinorrhoea
Initial treatment with ≥ 4/52 topical nasal steroid spray +/- oral antihistamine
If coloured discharge then use saline/bicarbonate douching plus 2 weeks oral ABs (Co-Amoxiclav or Clarithromycin)
Referral suitable for GPwSI

6. Douching

7. Hyposmia/Anosmia Initial Rx with ≥ 4/52 topical nasal steroid
Referral suitable for GPwSI

8. Rhinitis Large variability of response to differing TNS sprays.
Trial ≥ 2 different sprays + oral AH prior to considering referral
Flixonase, Nasonex & Avamys tend to be more successful than Beconase
Consider Dymista spray as 2nd line treatment
Referral suitable for GPwSI

9. Epistaxis

10. Age Refer >10 yrs <10 years Bleeding point seen
2/52 Naseptin Cream
Yes No
Success
Failure
2/52 Naseptin Cream
Cautery
Discharge
Failure
Success
Success
Failure
Discharge
Crusting / Vestibulitis ? No
Yes
Discharge
Success
2/52 Bactroban Ointment
Failure
Refer

11. Cautery Tips Lignocaine/Phenylephrine spray
Cotton wool soaked into nostril
Leave for 15 minutes
Fresh AgNO3 stick for each application
May take hrs for full effect

12. Facial Pain
If no nasal blockage or rhinorrhoea, then extremely unlikely to be sinus/nose related

13. (European Position Paper on Rhinosinusitis and Nasal Polyps 2007)
Inflammation of nose + sinuses characterised by ≥ 2 symptoms, one of which should be either nasal blockage/ obstruction/ congestion or nasal discharge (anterior/ posterior nasal drip):
± Facial pain or pressure,
± Hypo / anosmia;
AND EITHER signs of:
Polyps and/or;
Mucopus primarily from middle meatus and/or;
Oedema/mucosal obstruction primarily in middle meatus,
AND / OR CT changes:
Mucosal changes within OMC and / or sinuses

14. Facial Pain
If no nasal blockage or rhinorrhoea, then extremely unlikely to be sinus/nose related
Consider myofascial syndrome / tension-related disorders
Referral suitable for GPwSI

15. Hoarseness Intermittent Referral suitable for GPwSI / 2o care Constant
Consider voice care advice +/- PPI / Reflux advice
Referral suitable for GPwSI / 2o care
Constant
Refer via 2WW pathway

16. Globus Pharyngeus Are there red flag symptoms?
Pain, true dysphagia, weight loss, constant dysphonia
Smoker
If sensation of lump and intermittent without pain or true dysphagia, consider reflux / PPI trial
Referral suitable for GPwSI

17. ‘Catarrh’ / ‘Post nasal drip’

18. ‘Catarrh’ / ‘Post nasal drip’
Most likely globus-type diagnosis
If no nasal symptoms, extremely unlikely to be related to nose/sinus.
Psychogenic viscious circle
Advise re Voice care / Stop Throat Clearing / Reflux advice / PPI trial
Referral suitable for GPwSI

19. Snoring If unconnected to nasal blockage – Do not refer to ENT
‘Simple’ snoring
Wt loss, alcohol, mandibular advancement splint
Suspected OSA
Respiratory Department referral