Prevalence Of Chronic Rhinosinusitis Research Articles

Global Incidence and Prevalence of Chronic Rhinosinusitis: A Systematic Review.

Data on the global prevalence of chronic rhinosinusitis (CRS) is significantly varied and limited across countries and over time. Therefore, we aimed to conduct a comprehensive investigation into the global, regional, and national burden of CRS from the years 1980 to 2021, as well as identify those factors that influence levels of such burden. We conducted a systematic review and meta-analysis of general population-based observational studies focusing on CRS. We calculated pooled estimates of CRS prevalence and incidence with 95% confidence intervals (CIs). Subgroup analyses were conducted stratifying by sex, age cohorts, geographic regions, smoking status, obesity, and comorbid conditions. PubMed/MEDLINE, EMBASE, CINAHL, Google Scholar, and Cochrane databases. We included general population-based observational studies on CRS published from database inception through October 20, 2023. A total of 28 eligible studies, encompassing more than 237 million participants and 11,342,923 patients with CRS from 20 countries across four continents, were included in the analysis. Global pooled prevalence of CRS and CRS with nasal polyps (CRSwNP) was found to be 8.71% (95% CI, 6.69-11.33; number of studies, 20) and 0.65% (95% CI, 0.56-0.75; number of studies, 4), respectively. The prevalence of CRS was greater in Europe compared with North America, South America, and Asia; adults compared with children; smokers compared with never-smoker; those with obesity compared with normal weight; and those with comorbidities such as asthma, diabetes mellitus, eczema, and nasal septal deviation. Pooled prevalence of CRS increased from 1980 to 2020 (1980-2000: 4.72%; 95% CI, 2.12-10.49; 2014-2020: 19.40%; 95% CI, 12.12-31.07). Similar patterns were observed in CRS incidence. Our study provides valuable insights into CRS prevalence and incidence across diverse demographic and clinical factors, highlighting its increasing global burden. The reported prevalence of CRS varies internationally, and may be increasing over time. To enhance data quality and comparability, standardization of reporting methodologies is imperative. PROSPERO (registration no. CRD42024527805).

Search for medical information for chronic rhinosinusitis through an artificial intelligence ChatBot.

Artificial intelligence is evolving and significantly impacting health care, promising to transform access to medical information. With the rise of medical misinformation and frequent internet searches for health-related advice, there is a growing demand for reliable patient information. This study assesses the effectiveness of ChatGPT in providing information and treatment options for chronic rhinosinusitis (CRS). Six inputs were entered into ChatGPT regarding the definition, prevalence, causes, symptoms, treatment options, and postoperative complications of CRS. International Consensus Statement on Allergy and Rhinology guidelines for Rhinosinusitis was the gold standard for evaluating the answers. The inputs were categorized into three categories and Flesch-Kincaid readability, ANOVA and trend analysis tests were used to assess them. Although some discrepancies were found regarding CRS, ChatGPT's answers were largely in line with existing literature. Mean Flesch Reading Ease, Flesch-Kincaid Grade Level and passive voice percentage were (40.7%, 12.15%, 22.5%) for basic information and prevalence category, (47.5%, 11.2%, 11.1%) for causes and symptoms category, (33.05%, 13.05%, 22.25%) for treatment and complications, and (40.42%, 12.13%, 18.62%) across all categories. ANOVA indicated no statistically significant differences in readability across the categories (p-values: Flesch Reading Ease = 0.385, Flesch-Kincaid Grade Level = 0.555, Passive Sentences = 0.601). Trend analysis revealed readability varied slightly, with a general increase in complexity. ChatGPT is a developing tool potentially useful for patients and medical professionals to access medical information. However, caution is advised as its answers may not be fully accurate compared to clinical guidelines or suitable for patients with varying educational backgrounds.Level of evidence: 4.

Side- and Sinus-Specific Relationships between Chronic Rhinosinusitis and Ischemic Stroke Using Imaging Analyses.

Recent studies have reported chronic rhinosinusitis (CRS) as an independent risk factor for stroke. However, the association with stroke depending on the affected sinuses has not been explored. This study aimed to elucidate the side- and sinus-specific relationship between CRS and ischemic stroke through imaging analyses. We retrospectively reviewed the medical records of patients who were diagnosed with ischemic stroke at a tertiary center. CRS was defined as having a total score of greater than or equal to 4, according to the Lund-Mackay scoring system, through brain magnetic resonance imaging or computed tomography. We investigated the side- and sinus-specific correlation between CRS and ischemic stroke. Subgroup analyses were performed for different age groups. CRS prevalence in patients with ischemic stroke was 18.4%, which was higher than the previously reported prevalence in the general population. Overall, there was no correlation between the directions of the CRS and ischemic stroke (p > 0.05). When each sinus was analyzed, the frontal (Cramer's V = 0.479, p < 0.001), anterior (Cramer's V = 0.396, p < 0.001)/posterior (Cramer's V = 0.300, p = 0.008) ethmoid, and sphenoid (Cramer's V = 0.383, p = 0.005) sinuses showed a statistically significant correlation with the side of stroke, but the maxillary sinus (Cramer's V = 0.138, p = 0.208) did not. In subgroup analyses, a significant right-side correlation between the two diseases was observed in the older-age subgroup (≥65 years old, Cramer's V = 0.142, p = 0.040). Diabetes mellitus (odds ratio = 1.596, 95% confidence interval = 1.204-2.116) was identified as an independent risk factor for having CRS in patients with ischemic stroke. CRS of the frontal, anterior/posterior ethmoid, and sphenoid sinuses has a directional relationship with ischemic stroke. Our results on which sinuses correlate with stroke advocate for the active surveillance of CRS in patients at high risk of ischemic stroke.

Prevalence of chronic rhinosinusitis without/with nasal polyps according to severity in Spain.

The worldwide prevalence range of chronic rhinosinusitis (CRS) is 5-12%; from this, 20 % have nasal polyps. Due to the little epidemiological data about CRS in the Spanish population, this study analyses the prevalence and severity of CRS with (CRSwNP) or without (CRSsNP) nasal polyps, and their connection with other coexisting type 2 inflammatory diseases in Spain. This is a retrospective, large-scale, nationwide, epidemiological study based on the electronic medical records from the BIG-PAC® database. Patients diagnosed of CRSsNP and CRSwNP were identified using specific disease codes. The severe form of the disease was defined as patients who received at least a long course of antibiotics in CRSsNP or ≥2 short courses of systemic corticosteroids in CRSwNP in ≤12 months during the last 2 years, and/or had previous sinus surgery. Physician diagnosed prevalence, sociodemographic and clinical characteristics, and disease severity were assessed. Out of a cohort of 1,012,257 patients (≤18 years old), 42,863 and 7,550 patients with diagnosed CRSsNP and CRSwNP, respectively, were analysed. The overall prevalence of diagnosed CRS was 5.1%, being 4.3% and 0.8% for CRSsNP and CRSwNP, respectively. Patients with CRSwNP and severe forms of the disease were older and had higher levels of type 2 inflammatory biomarkers than CRSsNP patients and non-severe disease. Although CRSsNP was more prevalent than CRSwNP, the severe forms of CRS were more frequent in patients with CRSwNP. In addition, CRSwNP patients had a higher incidence of coexisting type 2 inflammatory diseases.

Prevalence of Chronic Rhino Sinusitis in Patients with Concha Bullosa.

This study aims to investigate the prevalence of chronic rhino sinusitis in patients with concha bullosa, a common anatomical variation characterised by pneumatization of the middle turbinates. Chronic rhino sinusitis is an inflammatory disorder of the paranasal sinuses and the linings of the nasal passages that lasts for 12weeks or longer. The incidence of chronic rhino sinusitis was assessed among patients with diagnosed concha bullosa, focusing on the presence of symptoms, and severity. There seems to be a strong relationship between concha bullosa and the development of chronic rhino sinusitis To screen the patients of concha bullosa for chronic rhino sinusitis. To find out of the percentage of chronic rhino sinusitis in patients with concha bullosa. To determine the sinuses affected and their respective sides. This is a retrospective study to investigate the incidence of chronic rhino sinusitis in patients diagnosed with concha bullosa. The study was conducted at Vydehi institute of medical science and research centre, Whitefield, Bangalore and the data from 01/02/23 to 01/09/23 were analyzed. Medical records of patients with diagnosed concha bullosa were identified through electronic medical records and imaging databases (CT scan paranasal sinuses). Inclusion criteria consisted of patients with a confirmed diagnosis of concha bullosa based on radiological imaging (CT scans) and clinical assessment.Exclusion criteria: patients with previous sinus surgeries and malignancy. The study's methods focused on retrospectively assessing the incidence of chronic rhino sinusitis in patients diagnosed with concha bullosa. In the above study it is concluded that concha bullosa plays major role in development of chronic rhino sinusitis. Thus after confirming the presence of concha bullosa practitioner should keep in mind the possibility of development of chronic rhino sinusitis.

Prevalence of Chronic Rhinosinusitis in the Jazan Region of Saudi Arabia

Background: Chronic rhinosinusitis (CRS) is one of the most common medical problems worldwide. It has a significant impact on the quality of life and productivity of many people. The prevalence of CRS varies throughout the world. In this study, we evaluated the prevalence of CRS in the Jazan region of Saudi Arabia. Methods: We conducted a cross-sectional study, using an online questionnaire to collect data on demographic, Sinonasal outcome test-22 (SNOT-22), chronic diseases, and smoking status. The prevalence was estimated based on the established diagnosis and a high SNOT-22 score with the presence of three of the cardinal symptoms of CRS. Variables associated with the presence of CRS were evaluated. Results: The 1081 contributors that met our inclusion criteria included 594 males and 487 females with a median (interquartile range) age of 31 (17) years. More than half of all participants (n = 653, 60.4%) had high SNOT-22 (&gt;18/110), but many did not fulfill the criteria for CRS in this study. Of the 1081, 215 had an established diagnosis and had three or more of the cardinal symptoms of CRS. In addition, 134 cases had not been clinically evaluated before but were suffering from three or more of the cardinal symptoms of CRS. Based on this, the estimated prevalence of CRS among our sample was 349 CRS patients (32.3%). CRS was less in people from mountainous areas (24.8%, P = 0.020). Conclusions: CRS was more prevalent in the hotter plains and coasts than in the mountains. Further studies are warranted to estimate the annual incidence and the impact on the health-care services as well as on the occupational and personal lives of the individuals.

Calidad de vida y características clínicas de pacientes con trasplante renal con y sin rinosinusitis crónica

Introduction: Transplantation is the treatment of choice for patients with chronic kidney disease (CKD). It requires immunosuppression, which predisposes to the development of complications; chronic rhinosinusitis (CRS) is one of the most signi cant. Objective: To compare the characteristics of patients with CKD and without CRS in a renal transplant protocol at a specialized hospital in Puebla, Mexico. Methods: A comparative, cross-sectional, retrospective study in patients with CKD and in renal transplant protocol at a third-level care hospital. The SNOT-22 and Lund-Mackay scales were applied. Descriptive statistics, Mann-Whitney U tests, Fisher's exact test, and Phi coefficient were used; p&lt;0.05 was considered signi cant.Results: 360 patients were recruited: 49 presented with CRS; prevalence: 13.61%; mean age: 39.22 ± 12.09 years and duration of progression: 17.73 ± 5.91 weeks. Naso-sinusal polyposis was present in 14.3%; nasal obstruction in 95.9%; facial pain in 67.3%; rhinorrhea in 49% and hyposmia/anosmia in 40.8%. Associated risk factors: allergy to acetylsalicylic acid (p=0.014) and atopy (p=0.000). Anatomical variants in patients with and without CRS, respectively: Agger nasi cell 95% and 15.4%; septal deviation, 50% and 6.4%; turbinate hypertrophy, 50% and 1.3%; concha bullosa, 30% and 4.2%; and paradoxical turbinate, 10% and 1.6%. The predominant quality of life impact in patients with and without CRS was moderate at 53.1% and mild at 97.1% (p=0.000). Conclusion: The prevalence of CRS was 13.61%; the associated risk factors were allergy to acetylsalicylic acid and atopy, and the predominant anatomical variant was Agger nasi. The tomographic severity was mild, and the impact on quality of life was moderate.

Acute and chronic rhinosinusitis age characteristics

Children's and adults' rhinosinusitis are two diseases that have both similarities and differences in anatomy, epidemiology, causes, pathogenesis, diagnosis and treatment. At the same rhinosinusitis is one of the most common in otorhinolaryngology's practice, both in children and adults. The of adults paranasal sinuses (PNS) anatomy differs from children's PNS anatomy. Although ostiomeatal complex occlusion is recognized as a major cause of poor ventilation and drainage of the adult paranasal sinuses, it does not have a strong effect on pediatric rhinosinusitis, but adenoids play a key role. Adenoids are bacteria and biofilms reservoirs that cause chronic refractory rhinosinusitis regardless of pharyngeal tonsil size. The prevalence of chronic rhinosinusitis (CRS) is lower in children than in adults. Diagnosis of children's rhinosinusitis is more difficult because nasal cavity endoscopic examination is performed rarely due to the occasional need of general anesthesia during the procedure. Moreover, it's necessary to take into account prevailing etiological role of viruses in ARS at children's age and chronic adenoiditis often accompanies pediatric CRS, which requires attention prescribing medical therapy as the basis of rhinosinusitis treatment. The DysheLORz based on Pelargonium sidoides roots is highly effective and safe for children's and adults ARS and CRS treatment, both as monotherapy and in combination with topical steroids and antibiotics. This herbal medicine immunomodulatory effect is mediated mainly by stimulating the production of TNF-α, IL-1, IL-12 and IFN-γ. It activates macrophages and improves their phagocytic activity. IL-12, together with TNF-α, enhances NK and cytotoxic CD8+ lymphocytes' activity against infected cells. IL-12 effect on Th1 lymphocytes maturation provides a link between innate and adaptive immunity. This is also increasing MCP-1, IP-10 and MIP-1β chemokines synthesis and decreasing MIP-1α, ENA-78, GROα and IL-8 production in PNS and nasal mucosa. This leads to decrease of neutrophils chemotaxis to the inflammation site, and decline of serine proteases concentration (neutrophils main enzymes), that increases mucous membrane epithelial barrier permeability, reducing bacterial infections risk. Additionally, Pelargonium sidoides increases epithelial cells beating cilia frequency and inhibits hemagglutinin and neuraminidase present on influenza virus surface. The drug increases antimicrobial peptides production as defensins, human neutrophil peptides (HNP) and bactericidal permeability-increasing protein (BPI), which is also important for rapid inflammation regression in rhinosinusitis. It causes bacterial adhesion to epithelial cells inhibition, phagocytosis stimulation, nitric oxide (NO) release and oxidative burst. The medicine had a direct effect on Streptococcus pneumoniae, Staphylococcus aureus, Neisseria, Moraxella catarrhalis and Haemophilus influenza. Based on these data, it is possible to explain the high effectiveness and safety of the drugs based on Pelargonium sidoides in ENT organs inflammation treatment, for both adults and children over 1 year old.

Association Between Smoking and Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.

Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the upper airway. The impact of smoking on CRS has not been clearly established. We aim to clarify the association between first-hand cigarette smoking and the prevalence and prognoses of CRS. PubMed, Embase, SCOPUS, and Cochrane Library were searched from inception until May 15, 2022. Three blinded reviewers selected relevant studies, extracted data, and evaluated study bias following a PROSPERO-registered protocol (CRD42022345585). We used random-effects meta-analyses to pool the prevalence of smoking in CRS, association between smoking status and CRS, and association of smoking with quality of life (QOL) before and after functional endoscopic sinus surgery (FESS). We also performed descriptive analyses of olfactory function, CT scores, and endoscopy scores before and after FESS. We included 23 cross-sectional studies, 19 cohort studies, two case-control studies, and one prospective clinical trial. The pooled prevalence of ever-smokers was 40% (95% CI = 0.30-0.51) and 33% (95% CI = 0.25-0.43) in patients with and without CRS. Compared to never-smokers, active smokers and past smokers had 1.35 (95% CI = 1.18-1.55) and 1.23 (95% CI = 1.17-1.29) higher odds of having CRS. Among patients with CRS, non-smokers reported higher initial QOL than smokers (standardized mean difference [SMD] = 0.23, 95% CI = 0.11-0.35), although post-FESS QOL was similar (SMD = 0.10, 95% CI = -0.30-0.51). Descriptive analysis found no significant correlations between smoking and post-FESS olfactory function and endoscopy scores. Cigarette smoking is associated with higher prevalence and odds of CRS. Clinicians should be aware that smoking predisposes to CRS, but does not negatively impact the rhinologic outcomes of FESS. Laryngoscope, 134:2513-2524, 2024.

Evaluating the Association of Obesity and Chronic Rhinosinusitis: A Systematic Review and Meta-analysis.

The aim of this Meta-analysis and systematic review was to perform a comprehensive assessment of the association of chronic rhinosinusitis (CRS) with overweight/obesity, leptin hormone, and its associated metabolic dysregulation. Ovid MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials,were searched for studies from 1946 to October 2022, using predefined syntax. Outcome data for the meta-analysis were extracted on odds ratios (OR) of CRS prevalence based on the presence of overweight/obesity and mean serum leptin levels. A Meta-analysis was performed using the DerSimonian-Laird estimator to pool extracted data by the generalized inverse variance approach. Random effect models were utilized due to the small sample size. A qualitative synthesis was performed on articles that did not meet the inclusion criteria for the Meta-analysis. Thirty-six studies met the systematic review inclusion criteria out of 1113 articles screened. A total of 6 studies were included in the pooled Meta-analysis of the various outcome variables. Our pooled meta-analysis observed a positive association between overweight/obesity and the prevalence of CRS (OR = 1.33, 95% confidence interval [CI]: 1.17-1.51). The pooled ratio of the means analysis of the mean serum leptin levels between CRS with nasal polyposis and control patients was 2.21 (95% CI: 1.45; 3.36). Our pooled Meta-analysis indicates a positive association between overweight/obesity and CRS. Future prospective studies are needed to explore the association between CRS and obesity with an understanding of potential confounding comorbidities, including studies focused on assessing the underlying immunologic mechanism of this association.

Pathophysiological features of chronic IgE-mediated rhinosinusitis of bacterial etiology

Chronic rhinosinusitis (CRS) is a disease caused by inflammation of the paranasal sinuses and its mucous membrane lasting for more than 4 weeks continuously. The aim of our study was to examine the main pathophysiological features of chronic IgE-mediated rhinosinusitis of bacterial etiology according to publications in the Russian Federation and in the world. A search was made through English- and Russian-language literature sources using the following databases: PubMed, MedLine, Web of Science, Russian Science Citation Index, Springer, Scopus, Scientific Research, Google Scholar, Crossref, eLibrary. The epidemiological features of CRS in the Russian Federation, bacterial pathogens and pathophysiological characteristics of CRS were analyzed. A 2-fold increase in the prevalence of CRS was registered over the past 20 years. Prevalence of the disease increases at longer age ranges. Chronic rhinosinusitis ranks first among all chronic diseases in the field of otorhinolaryngology. Allergic rhinitis, asthma, bronchiectasia, immunodeficiencies, cystic fibrosis, primary ciliary dyskinesia and autoimmune diseases are associated with CRS. The most common bacterial pathogens are S. aureus, Staphylococcus epidermidis and Propionibacterium acnes, Prevotella, Streptococcus and Veillonella, and some Gram-negative bacteria, e.g., Pseudomonas aeruginosa (P. aeruginosa), Proteus mirabilis and Klebsiella pneumoniae. Staphylococcus aureus (S. aureus) is involved in pathogenesis of nasal polyps. The colonizing bacteria may contribute to pathogenesis of CRS through the formation of biofilms. Alterations in the sino-nasal microbiome may also contribute to the development of CRS. An association of the CRS and CFTR gene mutations plays a significant role in the pathogenesis of chronic rhinosinusitis. An “immune barrier hypothesis” has been proposed as potential mechanism of CRS. Reduced expression of SPINK5, impaired STAT3 signaling, and T2R38 bitter taste receptor polymorphism have been identified in the pathogenesis of CRS. The T2R38 gene stimulates epithelial cells to produce nitrous oxide with a bactericidal effect, promotes mucociliary elimination of pathogens and prevention of upper respiratory tract infections, the polymorphism of this gene predisposes patients to gram-negative infectious diseases, and therefore is a risk factor for the development of CRS. In addition, antibody deficiency is the most common primary immunodeficiency associated with CRS.Hence, the pathogenesis of chronic IgE-mediated rhinosinusitis of bacterial etiology is associated with defects in innate immunity and mucociliary clearance, influence of the sinonasal microbiome, allergies, and genetic factors. A comprehensive assessment of these factors is necessary for the development of new preventive and therapeutic options for the correction of CRS.

Are statins effective in preventing chronic rhinosinusitis? A systematic review and meta-analysis.

To evaluate the association between statin use and chronic rhinosinusitis (CRS). Systematic review and meta-analysis. The methodological quality of studies was assessed using the Newcastle-Ottawa scale. Patients with CRS. Pooled odds ratios (ORs) with 95% confidence interval (CIs) in analyses of studies that compared the prevalence of CRS, nasal polyp, difference of Lund-Kennedy endoscopic score, Lund-Mackay CT score and Sino-nasal Outcome Test-22. The analysis included eight studies and 445 465 patients. Patients who used statins were at lower risk for CRS than those who did not (OR = 0.7457, 95% CI = 0.6629-0.8388, p < 0.0001, I2 = 0.0%). Patients with hyperlipidaemia were at higher risk for CRS than those with normal serum levels of lipid (OR = 1.3590, 95% CI = 1.2831-1.4394, p < 0.0001, I2 = 33.3%). However, there were no significant differences in the risk for nasal polyps between CRS patients using statins or not (OR = 1.0931, 95% CI = 0.7860-1.5202, p = 0.5968, I2 = 0.0%). Additionally, statin use was not related to Lund-Kennedy endoscopic scores, Lund-Mackay CT scores or sino-nasal outcome test-22 scores in CRS patients. The risk for CRS is lower in patients who use statins and those without hyperlipidaemia.

Residential Proximity to a Commercial Pesticide Application Site and Risk of Chronic Rhinosinusitis

Environmental and occupational toxicants have been shown to be associated with an increased prevalence of chronic rhinosinusitis (CRS). However, few to no studies have evaluated patients for CRS using objective testing and workup protocols that fulfill guidelines for CRS diagnostic criteria. Furthermore, no study, to our knowledge, has investigated the risks of CRS in the context of residential exposure through proximity to a commercial pesticide application site. To evaluate associations of residential proximity to a commercial pesticide application site and the prevalence of CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSwoNP). This was a retrospective cohort study of patients who presented to a tertiary care institution for rhinology evaluation between March 1, 2018, and December 31, 2022. The outcome variable was the clinical diagnosis of CRS (CRSwNP, CRSwoNP, or non-CRS control). Patients' residential addresses were utilized to determine pesticide exposure status based on a validated computational geographic information algorithm based on data from the California Pesticide Use Report System. The dichotomous independent variable of exposure status (exposed or non-exposed) was determined by assessing reports of any pesticide applications within 2000 m of each participant's residence in 2017. Multivariable logistic regressions assessing CRS status and CRS subtypes were conducted with pesticide exposure as the primary covariate of interest. The primary study outcome and measurements as well as study hypothesis were all formulated before data collection. Among a total of 310 patients (90 CRSwNP, 90 CRSwoNP, and 130 control), the mean (SD) age was 50 (17) years; 164 (53%) were female. Race and ethnicity information was not considered. Controlling for patient demographic information, smoking history, county of residence, and medical comorbidities, pesticide exposure was associated with an approximately 2.5-fold increase in odds of CRS (adjusted odds ratio, 2.41; 95% CI, 1.49-3.90). Pesticide exposure was associated with similar risks for CRSwNP (adjusted relative risk ratio [aRRR], 2.34; 95% CI, 1.31-4.18) and CRSwoNP (aRRR, 2.42; 95% CI, 1.37-4.30). The findings of this retrospective cohort study and analysis revealed that residential exposure to commercial pesticide application within a 2000-m buffer was independently associated with an approximately 2.5-fold increase in odds of being diagnosed with CRS. If validated by additional research, this association would have substantial implications for public health.

Body Mass Index and Related Risk Factor of Sinusitis Among Adults in Saudi Arabia: A Cross-Sectional Study.

Chronic rhinosinusitis (CRS) is a widespread condition worldwide that is leading to a significant burden on society in terms of healthcare consumption and productivity loss.Multiple risk factors have been implicated in the pathogenesis of CRS, such as nasal allergies, bronchial asthma, smoking, nasal polyps, and immune system-related diseases. The present study aimed to assess the prevalence of CRS, the most common risk factors, and the association between diabetes, body mass index(BMI), and CRS in Saudi Arabia. A cross-sectional study was conducted through random sampling that included 3602 participants from different regions of Saudi Arabia from November 2022 to January 2023. Electronic questionnaires were used for data collection. A total of 3602 individuals responded to our questionnaires; 948 (26.3%) were diagnosed by physicians as having chronic rhinosinusitis, and 75.1% were females. The majority (41.5%) were between the ages of 18 and 28 years. We found that smoking was significantly associated with sinusitis (OR 2.01, 95% CI 1.23-5.69) (p value 0.003) and that obesity was also significantly associated with sinusitis, 17.0% of persons with sinusitis were obese class I (BMI 30-35 kg/m2); 7.8% were obese class II (BMI>35 kg/m2); and 29.4% were overweight, whereas 45.8% were of normal weight. All percentages differ significantly from persons with normal weight (p value = 0.000). The most common risk factors for sinusitis were nasal allergies (44.4%), stuffy nose (22.8%), and deviation of the nasal septum (19.2%). All percentages differ significantly from persons without comorbidity (p value = 0.000). The present study showed a slight increase in the prevalence of CRS in Saudi Arabia, which is attributable to increased exposure to allergens. The most common risk factors were nasal allergies, nasal blockage, deviation of the nasal septum, and asthma. There was a significant correlation between CRS and BMI in the form of increased prevalence in overweight and obese compared to normal-weight individuals.

Functional Alteration and Differential Expression of the Bitter Taste Receptor T2R38 in Human Paranasal Sinus in Patients with Chronic Rhinosinusitis.

The bitter taste receptors (T2Rs) expressed in human sinonasal mucosae are known to elicit innate immune responses involving the release of nitric oxide (NO). We investigated the expression and distribution of two T2Rs, T2R14 and T2R38, in patients with chronic rhinosinusitis (CRS) and correlated the results with fractional exhaled NO (FeNO) levels and genotype of the T2R38 gene (TAS2R38). Using the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) phenotypic criteria, we identified CRS patients as either eosinophilic (ECRS, n = 36) or non-eosinophilic (non-ECRS, n = 56) patients and compared these groups with 51 non-CRS subjects. Mucosal specimens from the ethmoid sinus, nasal polyps, and inferior turbinate were collected from all subjects, together with blood samples, for RT-PCR analysis, immunostaining, and single nucleotide polymorphism (SNP) typing. We observed significant downregulation of T2R38 mRNA levels in the ethmoid mucosa of non-ECRS patients and in the nasal polyps of ECRS patients. No significant differences in T2R14 or T2R38 mRNA levels were found among the inferior turbinate mucosae of the three groups. Positive T2R38 immunoreactivity was localized mainly in epithelial ciliated cells, whereas secretary goblet cells generally showed lack of staining. The patients in the non-ECRS group showed significantly lower oral and nasal FeNO levels compared with the control group. There was a trend towards higher CRS prevalence in the PAV/AVI and AVI/AVI genotype groups as compared to the PAV/PAV group. Our findings reveal complex but important roles of T2R38 function in ciliated cells associated with specific CRS phenotypes, suggesting the T2R38 pathway as a potential therapeutic target for promotion of endogenous defense mechanisms.

Tobacco use increases the risk of chronic rhinosinusitis among patients undergoing endoscopic sinus surgery.

Although it has been postulated that tobacco use, as well as other environmental exposures, may contribute to chronic rhinosinusitis (CRS), the data remain limited. Here, we utilised a large state population database to assess the association between tobacco use and CRS prevalence among patients undergoing endoscopic sinus surgery (ESS). Employing a case-control study design, the Utah Population Database was queried for patients age >18 with a diagnosis of CRS and tobacco use who underwent ESS between 1996 and 2018. Smoking status was compared between patients with CRS (n=34 350) and random population controls matched 5:1 on sex, birth year, birthplace, time residing in Utah, and pedigree (i.e., familial) information (n=166 020). Conditional logistic regression models were used for comparisons between CRS patients and their matched controls. All analyses were repeated, additionally adjusting for race, ethnicity, tobacco use, asthma history, and interaction between tobacco use and asthma history. A total of 200 370 patients were included in the final analysis. Patients with CRS were significantly more likely to demonstrate a history of tobacco use than controls (19.6% vs. 15.0%; p <.001), with an adjusted odds ratio (aOR) of 1.42, 95% confidence interval 1.37-1.47; p < .001. More patients with CRS and comorbid asthma used tobacco (19.5%) than controls with asthma (15.0%; p < .001). History of tobacco use may portend increased risk for the development of CRS among patients undergoing ESS compared to healthy controls.

Prevalence and risk factors of chronic rhinosinusitis among Chinese: A systematic review and meta-analysis.

Chronic rhinosinusitis (CRS) can be seen in people of all ages. CRS heavily affects the quality of a patient's daily life and also causes tremendous economic burdens on patients' families and society. The prevalence of CRS in different countries varies and no systematic review of the prevalence of CRS among Chinese has been published previously. The objective of this systematic review and meta-analysis is to determine the prevalence of CRS among Chinese and to explore the main risk factors of CRS among Chinese. Using relevant keywords, data resources including PubMed, Scopus, Web of Science, Google Scholar, Embase, Cochrane Library, Chinese National Knowledge of Infrastructure (CNKI), WANGFANG, VIP, and China Biomedical Literature database (CMB) were searched to obtain literature reporting the prevalence of and risk factors of CRS among Chinese which were clearly diagnosed with CRS from inception to 30 June 2022. The random/fixed effect model was used for meta-analysis, and the I2 index was employed to assess heterogeneity among studies. All analyses were performed by using the STATA version 16.0 software. The study was registered with PROSPERO, register number. CRD42022341877. A total of 12 relevant kinds of literature were qualified for the present systematic review, including 4,033 patients. The results showed that the overall prevalence of CRS among Chinese was 10% (95%CI: 0.06-0.13, I2 = 99.6%, P < 0.001). The prevalence of CRS among Chinese who lived in urban cities was 18% (95%CI: -0.07 to 0.43, I2 = 99.9%, P < 0.001), which was obviously lower than the prevalence of CRS among Chinese who lived in rural areas (27%, 95%CI: -0.14 to 0.68, I2 = 99.8%, P < 0.001). The prevalence of CRS among Chinese before 2010 was 23% (95%CI: -0.05 to 0.50, I2 = 99.8%, P < 0.001), which was remarkably higher than the prevalence of CRS among Chinese after 2010 (7%, 95%CI: 0.05-0.09, I2 = 99.0%, P < 0.001). The prevalence of CRS among Chinese who were divorced was 17% (95%CI: 0.12-0.22, I2 = 0.0%, P = 0.436), while the prevalence of CRS among Chinese who were married, widowed, and unmarried was 9% (95%CI: 0.06-0.11, I2 = 88.1%, P = 0.004), 9% (95%CI: 0.06-0.11, I2 = 0.0%, P = 0.863), and 9% (95%CI: 0.08-0.10, I2 = 0.0%, P = 0.658), respectively. The prevalence of CRS among Han and minority Chinese was 8% (95%CI: 0.07-0.10, I2 = 69.6%, P = 0.070) and 12% (95%CI: 0.10-0.15, I2 = 38.6%, P = 0.202), respectively. The prevalence of CRS among Chinese who was never exposed to moldy or damp environments was 8% (95%CI: 0.08-0.09, I2 = 0.0%, P = 0.351), the prevalence of CRS among Chinese who was occasionally exposed to moldy or damp environments was 16% (95%CI: 0.10-0.22, I2 = 78.9%, P = 0.030), and the prevalence of CRS among Chinese who was frequently or every day exposed to moldy or damp environments was up to 20% (95%CI: 0.15-0.24, I2 = 0.0%, P = 0.558). This meta-analysis shows that the prevalence of CRS among Chinese is at a high level. People who have some risk factors, such as occasional or frequent or everyday exposure to moldy or damp environments, have a higher prevalence of CRS. We should attach more importance to the risk factors of CRS in clinical practice and disseminate scientific information and carry out education to lower the prevalence of CRS in China. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=341877, identifier: CRD42022341877.

A Decade of Clinical Advances in Chronic Rhinosinusitis: 2012–2022

The field of chronic rhinosinusitis (CRS) is constantly evolving. In the past 10 years, key advancements in basic and translational research as well as clinical studies have improved our understanding and management of CRS. Notably, treatment options have expanded to include novel therapeutic drugs, devices, and surgical techniques. Assessments of patient symptoms and their impact on quality of life have become more standardized. Progress has also been made in both determining the true prevalence of CRS and recognizing comorbidities that can impact CRS severity. Practice guidelines have also shifted from expert opinion to more data-driven analyses. This review highlights major clinical advancements made in the field of CRS over the past 10 years as well as identifies current gaps in knowledge that can form the basis for new areas of study over the next decade.

Association between outdoor air pollution and chronic rhinosinusitis patient reported outcomes

BackgroundThe aetiology of chronic rhinosinusitis (CRS) is multifactorial with a complex interplay between environmental, microbial endogenous and genetic factors. The impact of outdoor air pollution on prevalence or severity of CRS remains largely unknown.MethodsReal-life geolocation data (2017–2018, Belgium) from 278 CRS patients (2576 health records) using the mySinusitisCoach mobile application were analysed to calculate the patients’ individual exposure to outdoor air pollutants (ozone (O3), black carbon (BC), nitrogen dioxide (NO2) and particulate matter with diameter < 2.5 μm (PM2.5)) and to associate these pollutants with the patients’ sinus related symptoms measured at multiple occasions by visual analogue scale (VAS).ResultsThe adjusted seasonal model for the spring–summer (n = 1000 health entries, N = 83 patients) population revealed an increase of 6.07 (p < 0.0001) in overall CRS symptom scoring for an interquartile range (IQR) increase in exposure to O3 (26.9 μg/m3). An increase of 1.69 (p = 0.05) in total CRS symptom scoring was observed for an IQR increase of PM2.5 (7.1 µg/m3) exposure. Sex-stratified analysis in the spring–summer population showed significant interaction between air pollution and sex with male patients having higher total CRS symptom scores for an IQR increase in exposure to PM2.5 (3.52, p = 0.001), and O3 (8.33, p < 0.0001), while no significant association with symptom severity was seen in the female patients. In the analysis stratified by comorbid asthma, CRS patients with comorbid asthma had higher total CRS symptoms for an IQR increase in exposure to PM2.5 (2.58, p = 0.04) and O3 (7.72, p < 0.0001) while the patients without comorbid asthma had no significant symptom increases.ConclusionExposure to outdoor air pollution is associated with increased symptom severity in CRS patients. The extent to which CRS patients are sensitive to outdoor air pollution exposure varies per season and depends on their sex and comorbid asthma status. mHealth technology has the potential to reveal novel insights on the patients’ exposome and disease severity in the real-life situation.

The GA2LEN survey for chronic rhinosinusitis prevalence studies: Arabic translation, cultural adaptation, and validation

Background: Chronic rhinosinusitis (CRS) is a common disease that significantly impacts quality of life. Its prevalence varies between different geographical areas. This study aimed to validate the Arabic version of the EPOS criteria in the GA2LEN questionnaire to use it as a tool to estimate the prevalence of CRS in Arab countries. Methods: This is multicentric cross-sectional validation study. The original English EPOS criteria used in the GA2LEN survey (four main questions and two additional questions) were translated into Arabic. The study was conducted at King Abdulaziz University Hospital – Riyadh and Qatif Central Hospital – Qatif in the period between October 2020 and August 2021. Groups of CRS and non-CRS patients were selected randomly from databases of the hospital and asked to participate in the study through phone calls. Sensitivity, specificity, positive, and negative predictive values were calculated for the Arabic questionnaire. Results: Of 200 subjects contacted to complete the questionnaire, 128 agreed to participate and completed the survey. The Arabic version of the GA2LEN questionnaire was found to be reliable with high sensitivity and specificity. The reliability of the questionnaire increased when we added the question, “Has a doctor ever told you that you have chronic sinusitis?” to the main four questions. The sensitivity, specificity, and positive and negative predictive values were 93.9%, 59.6%, 71.25%, and 90.2%, respectively. Conclusions: The Arabic version of the EPOS criteria in the GA2LEN questionnaire is a valid and reliable tool for epidemiological studies to estimate the prevalence of CRS.