title: Societal and physician perspectives on sinonasal diagnosis and treatment.
abstract: BACKGROUND
  Sinusitis is diagnosed in 31 million individuals annually and has a significant impact on health care expenditures. Otolaryngologists understand that patient expectations, health knowledge, and the use of therapeutic options by patients and primary care physicians (PCPs) vary greatly. The intent of this study was to elucidate differences in the perspectives of patients, PCPs and otolaryngologists regarding the diagnosis and treatment of sinonasal disease.
  
  
  METHODS
  Three surveys were developed with questions targeting sinonasal infections: specifically, prevalence, diagnosis, physician prescribing patterns, treatment alternatives, and referral patterns to tertiary level physicians. Surveys were distributed to adult patients (n = 113) at general health fairs, whereas surveys for PCPs (n = 54) and otolaryngologists (n = 40) were obtained from teaching conferences and professional networking events.
  
  
  RESULTS
  In a description of viral upper respiratory tract infections (URIs), 43% of patients attributed symptoms to allergic rhinitis, 28% to URIs, and 28% to sinus infections. Despite this, 37% of patients still expected anti-bacterial agents. In patients with acute rhinosinusitis (ARS), 44% of patients would wait <1 week to see a physician whereas 82% of otolaryngologists and 57% of PCPs felt waiting 1 week or more was appropriate. In an ambulatory care setting, 45% of PCPs would chose to treat patients with 5 days of ARS symptoms whereas 32% of otolaryngologists would treat patients (p = .22). For ARS, 70% of patients expected antibiotics. Seventy percent of PCPs stated that they would refer a patient to an otolaryngologist after a single episode of sinusitis.
  
  
  CONCLUSIONS
  Patients with sinonasal symptoms confuse URIs for sinusitis and expect unnecessary treatment with antibiotics. PCPs and otolaryngologists vary regarding indications for presentation to a physician, approaches to therapy, and indications for referral to a tertiary provider in their respective practices.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, Saint Louis, Missouri, USA.
authors.forename: Shaulnie
authors.initials: S
authors.lastname: Mohan
authors.forename: Katelin
authors.initials: K
authors.lastname: Sisler
authors.forename: Kara
authors.initials: K
authors.lastname: Christopher
authors.forename: Joshua
authors.initials: J
authors.lastname: Hentzelman
authors.forename: Jastin
authors.initials: J
authors.lastname: Antisdel
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003625:Data Collection; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010036:Otolaryngology; D010361:Patients; D058007:Physicians, Primary Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D065631:Rhinitis, Allergic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D014777:Virus Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents