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Most of the recipes I have call for the fine or small hole attachment. I was wondering if anybody uses the medium or course attachment and if you do, what results are yielded? My sausage comes out tasting ok but it is very dense. Almost like a hotdog.

It seems to depend on the recipe as it's usually made. I use the larger hole plate for Italian sausage. Pick a recipe you like and try it both ways.

As NCPaul said, it depends on your taste. A lot of times I prefer a coarser grind to add texture.
Plus it is more appealing to the eye when you can see whole pieces of meat. Especially for serving to guests, they are more receptive if it looks like chopped meat (as opposed to mystery parts they can't recognize).

It also depends on the recipe or style of sausage. Historically meat was cut by hand so pieces were noticeably larger. Experiment. That's the beauty of home made sausage, try it and decide what you prefer.

The characteristics of some sausages call for a coarse grind because it's preferred to have large chunks of fat in the finished product (Sopresatta, Mortadella, maybe even Smoked Kielbasa or Andouille). I exclusively use the fine disk for all sausages I make. I find that its easier to mix the meat to get a nice distribution of meat/fat for appearance. The fat renders more evenly during grilling as well. It also eliminates that annoying chunk of fat that is inevitable with the coarse plate. If you are using the fine disk and your finished product is like a hot dog, then what's happening is that the fat is "smearing", and the meat is emulsifying during the grind. This happens when either the meat is not cold enough when grinding, or your cutter is extremely dull. First, try putting the meat in the freezer before grinding until almost frozen. That will cause it to shear cleanly during the grind. If you still have problems, you can either try to sharpen the cutter by moving it in a circular motion on a piece of 400 grit sandpaper set upon a pane if glass (because its flat), or just buy a new one, as they're not that expensive.

FWIW, I use various sized plates depending on the type of sausage I'm making.

Phil