Nasal airway obstruction: allergy and otolaryngology perspectives.
BACKGROUND
Diagnostic test preferences and management strategies for nasal airway obstruction (NAO) may vary depending on medical specialty.


OBJECTIVE
To discern current attitudes and practices of different medical specialties regarding diagnostic and management strategies for patients with NAO.


METHODS
Cross-sectional survey of all practicing otolaryngologists and medical allergists in Wisconsin and parts of northern Illinois (N = 268). Survey participants were asked to rank the tests they most commonly perform to differentiate causes of NAO and to rank the diagnostic tests they believed were most sensitive and specific (criterion standard) for NAO. The second portion of the survey provided 3 distinct patient scenarios, and participants were surveyed on their treatment plans.


RESULTS
The survey response rate was approximately 50% for both specialties. Nasal endoscopy was the most common diagnostic test for otolaryngologists vs allergists (58% vs 2%, P < .001), and allergy testing was most commonly used first by allergists (92% vs 0%, P < .001). Nasal endoscopy was considered the criterion standard for evaluating NAO by 70% of otolaryngologists vs 29% of allergists (P < .001), although nasal endoscopy was ranked in the top 3 for both specialties without a statistically significant difference. Patient scenario responses, however, demonstrated no statistically significant differences between the specialties.


CONCLUSIONS
Differences were demonstrated in the diagnostic workup preferences and perceptions of the criterion standard for NAO between the 2 medical specialties. Specialty bias, practitioner comfort level, and patient selection likely accounted for differences in responses. However, patient management decisions, medical or surgical, seemed to be similar between the specialties.
Shemirani
Nima L
NL
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Rhee
John S
JS
Chiu
Asriani M
AM
D000486:Allergy and Immunology / Q000639:trends*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004724:Endoscopy; D006801:Humans; D007087:Illinois; D007159:Immunologic Tests; D009296:Nasal Cavity; D014663:Nasal Decongestants / Q000627:therapeutic use; D015508:Nasal Obstruction / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D010036:Otolaryngology / Q000379:methods / Q000639:trends*; D010820:Physicians; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D012882:Skin Tests; D011795:Surveys and Questionnaires; D014922:Wisconsin; D000078329:Workforce
D014663:Nasal Decongestants