The association of premorbid diseases with chronic rhinosinusitis with and without polyps

Abstract

To review the recent insights regarding the epidemiology of adult chronic rhinosinusitis (CRS), with particular attention to its association with other premorbid conditions. Identifying premorbid disease associations establishes potential risk factors for developing CRS and helps corroborate current postulates of the various pathophysiologic mechanisms involved with the development and persistence of paranasal sinus inflammation. Recent findings demonstrate that the diagnosis of CRS is associated with a higher premorbid prevalence of upper airway diseases, lower airway diseases, gastroesophageal reflux disease, diseases of epithelial tissues, autoimmune disorders, and psychiatric conditions. Although some of these conditions have long been associated with CRS, improvements in study design and future studies in the general population will more accurately estimate the relative strengths of associations, clinical relevance, and temporal relationship of these various conditions in relation to the development of CRS. The predisposing patterns of premorbid illnesses may provide valuable information regarding the underlying causes of CRS and allow for both therapeutic and preventive interventions. There remains conflicting evidence within the literature regarding the association of CRS with some medical conditions, signifying the need for continued research on the subject. Limitations of the current studies include small sample sizes, lack of prospective longitudinal or interventional studies that help establish causality, and variable criteria for diagnosis of CRS in the outpatient setting.