Shortcomings in the diagnosis of chronic rhinosinusitis: evaluating diagnosis by otolaryngologists and primary care physicians.

BACKGROUND: Chronic rhinosinusitis (CRS) is a prevalent illness in the United States that accounts for 18-22 million physician visits annually. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has defined diagnostic criteria, but a recent study demonstrated that nearly all patients diagnosed by nonspecialists did not meet these criteria. In this study we aimed to evaluate the diagnostic rate of CRS by primary care physicians and otolaryngologists. METHODS: We retrospectively reviewed a random sample of adult patients diagnosed with CRS in 2016, based on ICD-10 codes from primary care and otolaryngology departments. Patients with previous CRS diagnosis, previous sinus surgery, and related comorbidities were excluded. RESULTS: A total of 502 patients with a new CRS diagnosis were analyzed (308 from primary care, 194 from otolaryngology). The percentage of diagnoses meeting the criteria was significantly higher from otolaryngology (28.9% vs 0.97%, p < 0.0001), but was low in both cohorts. Symptom duration <12 weeks was higher in primary care (81.6% vs 53.6%, p < 0.0001), as was lack of evidence of inflammation (97.4% vs 50.0%, p < 0.0001). Having <2 of the required symptoms was significantly higher in otolaryngology (63.8% vs 50.8%, p = 0.013). The most commonly unevaluated symptom was decreased sense of smell (97.7% in primary care, 69.1% in otolaryngology encounters). CONCLUSION: CRS diagnoses commonly do not meet the diagnostic criteria outlined by the AAO-HNS in both primary care and otolaryngology. As a specialty, we should aim to improve our adherence to the guidelines and educate our primary care colleagues to better identify patients with CRS and initiate appropriate treatment.

Block method of human temporal bone removal: a technical modification to permit rapid removal.

OBJECTIVES/HYPOTHESIS: To describe a technical modification to the block method (BM) of harvesting human cadaveric temporal bones for otolaryngology resident education and training. STUDY DESIGN: Human cadaveric study. METHODS: Human cadavers previously dissected by medical students in a professional health science program were identified as potential candidate specimens for temporal bone removal. Cadaveric heads were prepared for temporal bone harvesting by excising the calvarium and brain via standard techniques. A reciprocating saw was used to make four bone cuts to harvest two temporal bone specimens. RESULTS: Temporal bone specimens could be harvested using only four bone cuts to release both temporal bones from one human cadaver as opposed to four bone cuts for a single temporal bone per the traditional BM. All temporal bones were inspected and found to have all the anatomical landmarks necessary for resident education and training intact. CONCLUSIONS: The modified BM for temporal bone removal is a rapid, efficient, and reproducible method of harvesting two complete and intact temporal bones per cadaver with fewer bone cuts as compared to the traditional BM.