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Sinusitis F039

Document
Last amended 
30 May 2019

In this section

Current RMA Instruments

Reasonable Hypothesis SOP

73 of 2018

Balance of Probabilities SOP

74 of 2018

Changes from previous Instruments

SOP Bulletin 204

ICD Coding

  • ICD -9-CM Codes: 461, 473
  • ICD-10-AM Codes: J01, J32

Brief description

Sinusitis (or rhinosinusitis) is inflammation in the nasal cavity and the paranasal sinuses, which may be acute, recurrent acute, subacute or chronic.  Acute sinusitis is almost always due to viral infection.  Chronic sinusitis has a wide range of causative factors.

Confirming the diagnosis

The diagnosis of acute (rhino)sinusitis is based on the history and presenting symptoms.  The condition will typically resolve within 10 days and so whether a disease is present needs to be considered.  Recurrent acute sinusitis may represent discrete unrelated episodes, or there may be an underlying propensity such as from immunosuppression.  In the latter case it may be appropriate to diagnose the underlying condition and add "with recurrent sinusitis" to the diagnostic label.

For chronic (rhino)sinusitis (lasting 12 weeks or longer) diagnosis is based on the history plus demonstration of mucosal disease on examination (which may include rhinoscopy or endoscopy), or radiological imaging (CT or MRI scan).

Diagnosis can be made by a GP. The relevant medical specialist is an ENT surgeon.

Additional diagnoses covered by SOP

  • Abscess or empyema of the sinuses
  • Acute rhinosinusitis
  • Acute sinusitis
  • Chronic rhinosinusitis
  • Chronic sinusitis

Conditions not covered by SOP

  • Aerosinusitis* sinus barotrauma SOP
  • Barosinusitis* sinus barotrauma SOP
  • Allergic rhinitis*
  • Vasomotor rhinitis#

* another SOP applies

#   non-SOP condition

Clinical onset

Clinical onset for acute sinusitis will be when the current symptoms first manifest.  Earlier similar symptoms that resolved, followed by a symptom free period, are likely to represent a separate condition.  Chronic (rhino)sinusitis generally cannot be cured, but there may be periods of good symptom control.  For chronic sinusitis clinical onset will likely be when the first chronic symptoms attributable to the condition developed. 

Clinical worsening

Worsening should not generally be a consideration for acute (rhino)sinusitis.  For chronic sinusitis specialist medical advice should be sought as to whether worsening, beyond the normal course of the disease, has occurred.