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Use of advanced imaging technology and endoscopy for chronic rhinosinusitis varies by physician specialty

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Patients with chronic rhinosinusitis are cared for by multiple specialties. Endoscopy and imaging are important diagnostic tools. However, because physicians vary in their access to imaging and endoscopy, testing may vary across specialties. The purpose of this study is to characterize differences in use of imaging and endoscopy between physician specialties.


Using data from the National Ambulatory Medical Care Survey, we identified adult visits with primary, secondary, and tertiary diagnoses of chronic rhinosinusitis from 2005 through 2008. We measured rates of advanced radiographic imaging (CT, MRI, and PET) and office procedures. Logistic regression models were used to assess the bivariate and independent effects of patient, physician, and practice-level factors on use of advanced imaging and office procedures.


There were nearly 51 million visits for diagnoses coded as chronic rhinosinusitis, representing an average of 12.7 million visits annually. Primary care providers saw the majority of these patients. Otolaryngologists used advanced radiographic imaging at a rate higher than primary care physicians per outpatient visit (16.0% versus 1.93%; p < 0.001). Office procedures, performed almost exclusively (99.2%) by otolaryngologists, were performed at 24.5% of otolaryngology visits. Private insurance was significantly associated with a lower use of advanced radiographic imaging (odds ratio, 0.54; 95% CI, 0.31‐0.94) among otolaryngology visits, but no patient or provider-level variables were associated with office procedure use.


Radiographic imaging and office procedures are used at a higher rate per outpatient visit by otolaryngologists than by primary care providers. Additional studies are needed to identify and characterize factors that contribute to these different rates of use.

Keywords: Adult; National Ambulatory Medical Care Survey; chronic disease; computed tomography; endoscopy; health care surveys; otolaryngology/statistics and numerical data; physician's practice patterns/statistics and numerical data; rhinitis; rhinosinusitis; sinusitis

Document Type: Research Article

DOI: http://dx.doi.org/10.2500/ajra.2012.26.3817

Affiliations: Department of Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan, USA

Publication date: November 1, 2012

More about this publication?
  • The American Journal of Rhinology & Allergy, is a peer reviewed, scientific publication committed to expanding knowledge and publishing the best clinical and basic research within the fields of Rhinology & Allergy. Its focus is to publish information which contributes to improved quality of care for patients with nasal and sinus disorders. Its primary readership consists of otolaryngologists, allergists, and plastic surgeons. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    Previously published as American Journal of Rhinology, the journal is indexed in Thomson Reuters Web of Science and Science Citation Index, plus the National Library of Medicine's PubMed service.
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