Single use device endoscopy for the diagnosis of acute bacterial rhinosinusitis in primary care: A pilot and feasibility study.

Glinz, Dominik; Hansen, Jens Georg; Trutmann, Caroline; Schaller, Bernhard; Vogt, Jürg; Diermayr, Claus; Marti, Andreas; Leitmeyer, Katharina; Doerig, Patrick; Zeller, Andreas; Welge-Luessen Lemcke, Antje; Bucher, Heiner

OBJECTIVE Antibiotics are largely overprescribed for acute rhinosinusitis in primary care, mainly due to the lack of diagnostic tests to confirm or rule out bacterial infection. The study objective was to assess the on-site applicability and safety of the newly developed JGG endoscope® for the diagnosis of acute bacterial rhinosinusitis in primary care. DESIGN Five Swiss primary care centers and one university affiliated ENT unit participated in this single arm pilot-study. PARTICIPANTS Adults with acute suspected bacterial rhinosinusitis. The newly developed JGG endoscope® , which is attached to a pocket otoscope, was used to inspect the nasal cavity and middle meatus and to gain material for bacterial culture from paranasal sinuses draining ostium, after local anesthesia. MAIN OUTCOME MEASURES applicability and safety. RESULTS The visualization of the middle meatus was successful in 16 of 21 patients (13 in both sides and three in one side), and unclear or unsuccessful in five patients. Sample collection from the middle meatus was successfully in 10 patients (six on both and four on one side) and unclear or unsuccessful in the remaining patients. Only one culture confirmed bacterial rhinosinusitis and 11 PCR confirmed viral infections were identified from collected samples. After a two-weeks follow-up, no serious adverse events were observed. CONCLUSIONS The on-site use of the JGG endoscope® in daily primary care routine is feasible and safe and was well accepted by the trial physicians and patients (assessed with structured questionnaires). The JGG endoscope® may support general practitioners to differentiate between bacterial and viral rhinosinusitis.