title: Occupational and environmental risk factors for chronic rhinosinusitis: a systematic review.
abstract: BACKGROUND
  Chronic rhinosinusitis (CRS) is a prevalent and disabling paranasal sinus disease, with a likely multifactorial etiology potentially including hazardous occupational and environmental exposures. We completed a systematic review of the occupational and environmental literature to evaluate the quality of evidence of the role that hazardous exposures might play in CRS.
  
  
  METHODS
  We searched PubMed for studies of CRS and following exposure categories: occupation, employment, work, industry, air pollution, agriculture, farming, environment, chemicals, roadways, disaster, and traffic. We abstracted information from the final set of articles across 6 primary domains: study design; population; exposures evaluated; exposure assessment; CRS definition; and results.
  
  
  RESULTS
  We identified 41 articles from 1080 manuscripts: 37 occupational risk papers, 1 environmental risk paper, and 3 papers studying both categories of exposures. None of the 41 studies used a CRS definition consistent with current diagnostic guidelines. Exposure assessment was generally dependent on self-report or binary measurements of exposure based on industry of employment. Only grain, dairy, and swine operations among farmers were evaluated by more than 1 study using a common approach to defining CRS, but employment in these settings was not consistently associated with CRS. The multiple other exposures did not meet quality standards for reporting associations or were not evaluated by more than 1 study.
  
  
  CONCLUSIONS
  The current state of the literature allows us to make very few conclusions about the role of hazardous occupational or environmental exposures in CRS, leaving a critical knowledge gap regarding potentially modifiable risk factors for disease onset and progression.
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, PA.
authors.forename: Agnes S
authors.initials: AS
authors.lastname: Sundaresan
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, PA.
authors.forename: Annemarie G
authors.initials: AG
authors.lastname: Hirsch
authors.affiliation: Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD.
authors.forename: Margaret
authors.initials: M
authors.lastname: Storm
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Tan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Geisinger Health System, Danville, PA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Kennedy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Geisinger Health System, Danville, PA.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Greene
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kern
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, PA.|Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Schwartz
mesh_terms: D000818:Animals; D002908:Chronic Disease; D004781:Environmental Exposure / Q000009:adverse effects; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects; D015995:Prevalence; D012220:Rhinitis / Q000453:epidemiology*; D012307:Risk Factors; D012852:Sinusitis / Q000453:epidemiology*; D014481:United States
keywords: environmental health; epidemiology; farming; occupational health; sinusitis