Risk Factors and Comorbidities in Chronic Rhinosinusitis

Abstract

Chronic rhinosinusitis (CRS) is a heterogeneous disorder that creates a significant burden on the healthcare system. It is caused by a combination of inflammatory, environmental, and host factors; however, the precise mechanism of how each factor leads to CRS continues to be a source of debate. Previous data regarding this topic is often inconsistent or of lower quality. In this article, we review the recent literature on the risk factors and comorbidities in CRS. Large population-based studies have helped establish smoking as a significant risk factor for CRS. The focus has now shifted towards smoking and its effect on long-term outcomes after endoscopic sinus surgery (ESS). Ciliary dyskinesia, both primary and secondary, can affect both the sinonasal cavity and lower airways simultaneously by decreasing the beat frequency of cilia and inducing mucostasis. The effects of secondary dyskinesia may be reversible and there is some evidence to suggest the use of topical mucolytics in patients with CRS. Allergy and variants of sinonasal anatomy have been hypothesized to increase the risk of developing CRS by inducing chronic inflammation and obstructing the sinus ostia. Nevertheless, emerging data regarding these topics continue to produce inconclusive results. Inflammation of the upper and lower airways can occur simultaneously as seen in patients with asthma and aspirin sensitivity. The connection between these pro-inflammatory disease states has been known for many years. Newer evidence include large population-based studies and studies that correlate objective tests, such as computer tomography scans to pulmonary function tests. However, the treatment of CRS and its effects on obstructive airway disease continues to be a topic of debate. More large prospective studies are needed in order to continue refining our knowledge of the disease processes in CRS.

Risk of obstructive sleep apnea in African American patients with chronic rhinosinusitis

“…24,25 Future studies are needed to investigate whether the increased risk of OSA in the setting of CRS is linked to any of these genetic alterations. Furthermore, other lifestyle risk factors for OSA, such as smoking, 26,27 which is also a major risk factor for CRS 28 and is more commonly practiced and sustained into adulthood among African Americans, 29 might be playing a role in this increased risk. The burden of sleep symptoms and risk of hypertension in the setting of OSA is higher among African Americans compared with other races.…”

Effect of diabetes mellitus on postoperative endoscopic sinus surgery outcomes

“…CRS is a multifactorial inflammatory disease with influence from genetic, environmental, and host factors . Typically, surgical treatment, predominantly ESS, is offered when medical therapy with trials of antibiotics and/or nasal and systemic steroids fails, or if complications occur or are suspected.…”

Risk factors for post-9/11 chronic rhinosinusitis in Fire Department of the City of New York workers

“…Additionally, Bhattacharyya found that improvement in air quality was associated with a decrease in the prevalence of sinusitis 16. Cigarette smoking has also been linked to an increased risk of CRS,17 although ever smoking was not associated with CRS in our study population.…”