Concerns raised about rhinosinusitis management.(Clinical Rounds)

SAN ANTONIO -- Primary care physicians and otolaryngologists are both over-diagnosing and undertreating chronic rhinosinusitis, according to a new study from the University of Mississippi.

"There is a giant knowledge gap, which can lead to suboptimal outcomes," S. Rubina Inamdar, M.D., said in presenting the findings in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

"Although allergists are well equipped to treat [chronic rhinosinusitis], they are often overlooked as consultants," she said.

The retrospective study of more than 3,000 patients who were diagnosed with chronic rhinosinusitis (CRS) by primary care physicians concluded that consultations with allergists are underutilized, and as a result, many patients undergo unnecessary surgery without adequate trials of medical therapy "Even though these patients had chronic congestion and chronic nasal symptoms, very few of them had been given intranasal corticosteroids, while many were given only antihistamines and decongestants," said Dr. Inamdar, an allergist, of the University of Mississippi Medical Center in Jackson.

"And if their symptoms persisted, very few of them were given a CT scan--one of the key modalities for diagnosing chronic rhinosinusitis," Dr. Inamdar added.

Ultimately, if the patients' symptoms still persisted, they were referred more frequently to otolaryngologists rather than allergy specialists, she told this newspaper.

Out of a total of 3,063 patients with a CRS diagnosis from primary care physicians, 662 were referred to otolaryngologists and 309 were referred to allergists. There were 47 patients with a history of sinus surgery who were not referred for either an otolaryngology or allergy consult.