Indications to refer a patient with rhinosinusitis:
(1) unilateral mass, polyp or other finding
(2) hemorrhage
(3) proptosis or diplopia
(4) maxillary paresthesias
(5) orbital swelling or erythema
(6) immunocompromised status (including immunosuppression and AIDS)
(7) suspicion for intraorbital and/or intracranial complication
Additional items that could be added:
(8) failure to respond to therapy as expected
(9) evidence of an autoimmune disease (referral to a rheumatologist)
(10) antibiotic resistant organism (referral to an infectious disease specialist)
(11) association with a congenital anomaly
(12) association with maxillary dental infection (referral to a dental surgeon)
