title: A diagnostic dilemma: chronic sinusitis diagnosed by non-otolaryngologists.
abstract: Ambulatory care visits for chronic sinusitis outnumber visits for acute sinusitis. The majority of these visits are with non-otolaryngologists. In order to better understand patients diagnosed with chronic sinusitis by non-otolaryngologists, we sought to determine if incident cases of chronic sinusitis diagnosed by primary care (PC) or emergency medicine (EM) providers meet diagnostic criteria.
  
  
  
  This was a retrospective cohort study. Patients were identified using administrative data from 2005 to 2006. The dataset was then clinically annotated based on chart review. We excluded prevalent cases.
  
  
  
  We identified 114 patients with newly diagnosed chronic sinusitis in EM (75) or PC settings (39). Rhinorrhea (EM 61%, PC 59%) and nasal obstruction (EM 67%, PC 64%) were common in both settings but facial fullness (EM 80%, PC 39%) and pain (EM 40%, PC 18%) were more common in the EM setting. Few patients reported symptoms of 90 days or longer (EM 6.0%, PC 24%) and no patient had evidence of inflammation on physical examination. A minority of patients received a sinus computed tomography (CT) scan (22.8%) or nasal endoscopy (1.8%). In total, only 1 patient diagnosed with chronic sinusitis met the diagnostic criteria.
  
  
  
  Most patients diagnosed with chronic sinusitis by non-otolaryngologists do not have the condition. Caution should be used in studying chronic sinusitis using administrative data from non-otolaryngology providers because a large proportion of the patients may not actually have the disease.
authors.affiliation: Department of Otolaryngology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Novis
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Akkina
authors.affiliation: Department of Otolaryngology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Shana
authors.initials: S
authors.lastname: Lynn
authors.affiliation: University of Michigan, Ann Arbor, MI.
authors.forename: Hayley E
authors.initials: HE
authors.lastname: Kern
authors.affiliation: Michigan Institute for Clinical and Health Research. Ann Arbor, MI.
authors.forename: Nahid R
authors.initials: NR
authors.lastname: Keshavarzi
authors.affiliation: Department of Otolaryngology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pynnonen
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003951:Diagnostic Errors; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging; D058007:Physicians, Primary Care; D012189:Retrospective Studies; D012852:Sinusitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D013256:Steroids
keywords: chronic disease; chronic rhinosinusitis; computed tomography; endoscopy; evidence-based medicine; rhinosinusitis; sinusitis