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 Retrospective cohort. Patients were identified using administrative data, 2005–2006. 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 CT scan (22.8%) or nasal endoscopy (1.8%). In total only 1 patient diagnosed with chronic sinusitis met the diagnostic criteria. Conclusions 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 as a large proportion of the patients may not actually have the disease.

Objectives and Hypothesis Our objectives were to characterize the quality of acute sinusitis care and to identify non-clinical factors associated with antibiotic use for acute sinusitis. We hypothesized that we would identify provider level factors associated with antibiotic use. Study Design Retrospective cohort at a single academic institution. Methods We developed and clinically annotated an administrative dataset of adult patients diagnosed with acute sinusitis between January 1, 2005 and December 31, 2006. We used identify factors associated with receipt of antibiotics. Results We find that 66.0% of patients with mild symptoms of short duration are given antibiotics and that non-clinical factors, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence antibiotic use. Relative to internal medicine providers, family medicine providers use fewer antibiotics and emergency medicine providers use more antibiotics for acute sinusitis. Conclusions Antibiotics continue to be over used for patients with mild acute sinusitis of short duration. Non-clinical characteristics, including the individual provider, the provider's specialty, and the presence of a medical trainee significantly influence use of antibiotics for acute sinusitis.