THE IMPACT OF AIR POLLUTION ON CHRONIC RHINOSINUSITIS: A MULTI-CENTER OBSERVATIONAL STUDY

Abstract

In a multi‐center observational cohort of 300 adults with European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS)–defined chronic rhinosinusitis enrolled from five tertiary otolaryngology clinics, we quantified individual long‐term residential exposures to PM₂.₅ (22.7–28.1 µg/m³), NO₂ (30.1–37.5 ppb), and O₃ (43.2–48.1 ppb) using geocoded land‐use regression and satellite‐derived aerosol optical depth models, and assessed CRS severity via SNOT-22 (mean 42.7 ± 1.8) and Lund–Mackay CT scores (mean 12.5 ± 0.6). After adjusting for age, sex, smoking, asthma, socioeconomic status, and occupational exposures, each 1 µg/m³ increment in PM₂.₅ was associated with a 1.15-point increase in SNOT-22 (95% CI: 0.80–1.50; p = 0.001), while NO₂ (β = 0.98; 95% CI: 0.60–1.36; p = 0.005) and O₃ (β = 0.85; 95% CI: 0.50–1.20; p = 0.02) also significantly correlated with higher symptom scores. In logistic models, each 5 µg/m³ rise in PM₂.₅ increased odds of severe CT findings (Lund–Mackay ≥ 14) by 1.45 (95% CI: 1.10–1.91; p = 0.002), and each 5 ppb rise in NO₂ by 1.30 (95% CI: 1.02–1.65; p = 0.03). In a biopsy subset (n = 100), nasal mucosal IL-6, IL-8, and TNF-α levels exhibited dose–response increases across PM₂.₅ quartiles (p < 0.001 for trend). These findings demonstrate that ambient air pollution independently exacerbates CRS symptom burden, radiologic severity, and mucosal inflammation, underscoring the need to integrate environmental risk mitigation into clinical management and public health strategies for chronic sinonasal disease..