title: The role of secondhand smoke in sinusitis: a systematic review.
abstract: BACKGROUND
  The objective of this study was to systematically review existing literature on the association between sinusitis and secondhand smoke (SHS) exposure.
  
  
  METHODS
  We performed a literature search encompassing the last 25 years in PubMed, EMBASE, and Cochrane CENTRAL. Inclusion criteria included English language papers containing original human data with at least 7 subjects. Data was systematically collected on study design, patient demographics, clinical characteristics/outcomes, and level-of-evidence (Oxford Center for Evidence-Based Medicine). Quality assessment was performed using the Newcastle-Ottawa scale. Two investigators independently reviewed all manuscripts.
  
  
  RESULTS
  The initial search yielded 116 abstracts, of which 19 articles were included. Thirteen (68.4%) of the 19 articles showed a statistically significant association between sinusitis and SHS. Seven (36.8%) studies specifically evaluated chronic rhinosinusitis (CRS) with 5 (71.4%) CRS studies demonstrating a significant association between CRS and SHS. Seventeen articles were case-control studies (Level 3b). For characterizing sinusitis, 6 (31.6%) studies included computed tomography (CT) or endoscopy in the diagnostic criteria, with 5 of these studies following rhinosinusitis taskforce guidelines. For determining presence of SHS, all studies used questionnaires and 2 (10.5%) studies also reported serum or urine cotinine levels.
  
  
  CONCLUSIONS
  A majority of the studies (68.4%) included in this systematic review showed a significant association between sinusitis and SHS. Furthermore, 5 (83.3%) of the 6 studies with objective diagnostic criteria (CT, endoscopy) found a significant association between sinusitis and SHS. Further higher-quality studies with objective diagnosis of sinusitis and quantification of SHS exposure should be performed in the future to better evaluate the relationship between sinusitis and SHS.
authors.affiliation: Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD.
authors.forename: Kevin
authors.initials: K
authors.lastname: Hur
authors.forename: Jonathan
authors.initials: J
authors.lastname: Liang
authors.forename: Sandra Y
authors.initials: SY
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D012220:Rhinitis / Q000453:epidemiology*; D012307:Risk Factors; D012852:Sinusitis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution
keywords: chronic sinusitis; passive smoking; secondhand smoke; sinusitis; systematic review; tobacco smoke pollution