10 Indications For Referring Patients

These recommendations for patient referral are all based on the premise that the problem is recurrent or chronic over a long period of time. The parent or patient can usually clarify the chronicity of the problem more easily and accurately than reviewing the medical record because these problems alone often don’t prompt office visits.

  1. Adults with chronic post-nasal drip, nasal congestion and facial pressure. You may have to ask them since most patients probably believe nothing more can be done for this.
  2. Any patient who has a family history of sinus disease or nasal polyps and who has chronic nasal and sinus symptoms.
  3. Children with unrelenting nocturnal cough or mouth breathing, especially in children under the age of ten. With practice you can hear the hyponasal speech of the chronic nasal and sinus patient.
  4. Chronic use of Afrin, Neosynephrine or other OTC nasal sprays and all patients that use daily “D medications†(Claritin D, Zyrtec D, Allegra D, SudapheD, etc.). If appropriate we can often restore a normal nasal airway with a 20-minute in-office inferior turbinate reduction under local anesthesia and get them off these medications.
  5. The sleep apnea patient who cannot tolerate his CPAP or biPAP machine because of nasal and sinus complaints. These patients often require very high pressures due to the narrow nasal passages and that leads to discomfort and poor compliance.
  6. Recurring sinus infections in any adult or child despite appropriate anti-inflammatory medications such as antihistamines and topical nasal steroids. Generally at least three to four infections a year for several years is an indication to intervene.
  7. A history of severe infection in an adult or child that caused a complication such as pneumonia, orbital or peri-orbital cellulites/abscess, asthma attack or hospitalization.
  8. The chronically congested child or adult with a medical problem such as sleep apnea, asthma, cystic fibrosis or pulmonary disease which is exacerbated by their chronic sinus condition.
  9. Difficult-to-diagnose headache patients with significant nasal and sinus symptoms. Rectifying the nasal and sinus problems can greatly facilitate diagnosis of their headaches if they persist.
  10. Patients who may have had sinus surgery in the past that was not effective and who are still symptomatic.
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