title: 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.
authors.affiliation: Temple Head & Neck Institute, 3440 N. Broad Street, Kresge West 3rd Floor, Philadelphia, PA, 19140, USA.
authors.forename: Derrick
authors.initials: D
authors.lastname: Tint
authors.affiliation: Lewis Katz School of Medicine at Temple University, 3500 N. Broad Street, Philadelphia, PA, 19140, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kubala
authors.affiliation: Temple Head & Neck Institute, 3440 N. Broad Street, Kresge West 3rd Floor, Philadelphia, PA, 19140, USA. elina.toskala@temple.edu.
authors.forename: Elina
authors.initials: E
authors.lastname: Toskala
mesh_terms: D001249:Asthma / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D006801:Humans; D006967:Hypersensitivity / Q000150:complications; D012220:Rhinitis / Q000150:complications / Q000453:epidemiology*; D012307:Risk Factors; D012852:Sinusitis / Q000150:complications / Q000453:epidemiology*; D012907:Smoking
keywords: Allergy; Asthma; Chronic rhinosinusitis; Comorbidities; Risk factors; Smoking