A diagnostic dilemma: chronic sinusitis diagnosed by non-otolaryngologists

Int Forum Allergy Rhinol. 2016 May;6(5):486-90. doi: 10.1002/alr.21691. Epub 2016 Jan 11.


Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: chronic disease; chronic rhinosinusitis; computed tomography; endoscopy; evidence-based medicine; rhinosinusitis; sinusitis.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Chronic Disease
  • Diagnostic Errors*
  • Emergency Medical Services*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Paranasal Sinuses / diagnostic imaging
  • Physicians, Primary Care*
  • Retrospective Studies
  • Sinusitis / diagnosis*
  • Sinusitis / diagnostic imaging
  • Sinusitis / drug therapy
  • Sinusitis / epidemiology
  • Steroids / therapeutic use
  • Tomography, X-Ray Computed


  • Anti-Bacterial Agents
  • Steroids