From the Guidelines
You should go to the emergency room for sinusitis if you experience severe symptoms that suggest complications, including high fever, severe headache, mental confusion, changes in vision, facial swelling or redness that is spreading, stiff neck, or difficulty breathing, as indicated by the most recent guidelines 1. These symptoms may indicate that the sinusitis has spread beyond the sinuses to nearby structures like the brain, eyes, or facial tissues, which can be life-threatening and require immediate medical attention. Some key points to consider when deciding whether to refer a patient to the emergency room for sinusitis include:
- Severe symptoms such as high fever (over 102°F), severe headache, mental confusion, changes in vision, facial swelling or redness that is spreading, stiff neck, or difficulty breathing 1
- Persistent vomiting, inability to take fluids, or worsening symptoms despite appropriate treatment 1
- Signs of orbital or intracranial complications, such as proptosis, impaired visual acuity, or impaired and/or painful extraocular mobility 1
- Presence of underlying conditions that may increase the risk of complications, such as diabetes, immune-compromised state, or a history of facial trauma or surgery 1 It is essential to note that most cases of sinusitis can be treated in outpatient settings with antibiotics, nasal saline irrigation, decongestants, and pain relievers, and that emergency care is typically reserved for cases with severe symptoms or complications 1. In general, the diagnosis of acute sinusitis is based on clinical criteria, including symptoms such as nasal congestion, purulent rhinorrhea, postnasal drainage, facial or dental pain, headache, and cough, and physical examination findings such as tenderness overlying the sinuses, dark circles beneath the eyes, and/or peri-orbital edema 1. Imaging studies, such as CT or MRI, may be necessary in cases where complications are suspected or to confirm the diagnosis in uncertain cases 1. Overall, the decision to refer a patient to the emergency room for sinusitis should be based on a thorough evaluation of their symptoms, medical history, and physical examination findings, and should take into account the potential risks and benefits of emergency care.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Indications for Emergency Room Referral
When to refer a patient to the emergency room for sinusitis depends on the severity of symptoms and potential complications. The following are indications for emergency room referral:
- Severe symptoms, such as unilateral facial pain or pressure, fever greater than 102°F (39°C), and purulent nasal discharge with obstruction of the nasal passages that worsen over time 2
- Significant worsening of symptoms after 3 to 5 days or 7 or more days of symptoms 2
- Concern about complications, such as orbital cellulitis, meningitis, or abscess 2, 3
- Orbital involvement, which can present with or without ocular pain, especially in children with acute ethmoidal rhinosinusitis 3
- Isolated sphenoid sinusitis, which can be associated with significant ophthalmologic or neurological complications 3
- Post-sinus surgery complications, such as orbital pain or other severe symptoms 3
Diagnostic Considerations
Diagnostic testing for acute rhinosinusitis, such as antral puncture, is impractical due to its invasiveness 2. Computed tomography may be considered for patients with recurrent rhinosinusitis or concern about complications 2. Referral to an otolaryngologist should also be considered in these cases 2.