Training, practice, and referral patterns in rhinologic surgery: Survey of otolaryngologists

Objectives: Rhinology, which encompasses clinical and surgical treatment of the nasal cavity and paranasal sinuses, is a growing subspecialty with advances in the surgical, clinical, and research realms. The advancement of this subspecialty and its impact on the practice of otolaryngology, in both academic and nonacademic institutions, is not yet understood. Methods: A novel survey created by our research team was mailed out to 150 randomly selected otolaryngology staff and 8 fellowship-trained rhinologists throughout Canada asking questions related to demographics, training, referral patterns, technique, and adequacy of training. Results: One hundred respondents completed the survey, yielding a response rate of 63%. The average age of rhinologists who responded (38 years) was younger than those who were nonrhinologists (50 years). Compared with fellowship-trained rhinologists, nonrhinologists felt less comfortable with cerebrospinal leak repairs, skull base surgery, frontal sinus surgery, paranasal sinus neoplasm removal, and sphenopalatine artery ligation. Conclusions: Rhinology is a distinct subspecialty with new fellowship opportunities combined with advances in surgical technique, clinical treatments, and research opportunities. There are procedures that can be performed by both rhinologists and nonrhinologists; however, there is a subset of procedures that nonrhinologists do not feel comfortable performing. These procedures should be referred to fellowship-trained rhinologists who practice out of academic centres.