Category
Threshold Criteria
The policy’s criteria for rhinoplasty/Septorhinoplasty based on the signs and symptoms of medical issues only (i.e., improving an obstructed nasal airway). This sometimes requires sinus surgery to be performed at the same time. LLR ICB does not commission rhinoplasty/septo-rhinoplasty for cosmetic reasons.
Red flags/ concerning features
Patients presenting with these symptoms should be fast tracked for assessment and treatment if the condition is related to these “red flags”
- Unilateral facial swelling,
- History of possible foreign body
- Suspicion of CSF leak
- Unilateral nasal polyp
Patients assessed as not requiring treatment for red flag symptoms should be managed under the normal pathway set out in this policy.
Eligibility
| LLR ICB has deemed that rhinoplasty or septo-rhinoplasty should not be routinely commissioned unless criteria 1, 2 AND 3 are met: 1. Continuous nasal airway obstruction resulting in significantly impaired nasal breathing is present 2. There is an association with septal or lateral nasal wall pathology or vestibular stenosis 3. Symptoms persist despite conservative treatment measures for a minimum of three months. Sometimes a septoplasty is performed to gain access during endoscopic ethmoidectomy. |
| OTHER TREATMENTS NOT ROUTINELY FUNDED – Rhinoplasty intended to only improve the external appearance of the nose is NOT ROUTINELY FUNDED – The ICB will not normally approve funding for patients who are unhappy with the outcome of previous surgeries including immediate post-trauma corrections (whether provided by the NHS or private providers) or for snoring. – If the patient has had previous nasal surgery, revision will only be undertaken for functional reasons and not to improve appearance. Requests for funding for assessment or treatment for conditions that are not listed above should be submitted on an Individual Funding Request application form. |
| The INDIVIDUAL FUNDING REQUEST process, forms and guidance are available via PRISM, under Individual Funding Request (IFR) The panel will focus on the following Are there any clinical features of the patient’s case which make the patient significantly different to the general population of patients with the condition in question at the same stage of progression of the condition? Would the patient be likely to gain significantly more benefit from the requested intervention than might normally expected for the general population of patients with the same condition at the same stage of the progression of the condition? |
Guidance
| Ear, nose and throat conditions | Topic | NICE Surgical intervention for chronic rhinosinusitis – EBI (aomrc.org.uk) |
| ARP 74 Review Date: 2027 |
English 
Polish 
Romanian 
Arabic 
Gujarati 
Panjabi 
Urdu 