“Although it has been postulated that tobacco use, as well as other environmental exposures, may contribute to chronic rhinosinusitis (CRS), the data remain limited,” Amarbir S. Gill, MD, and colleagues wrote.

For a study published in Clinical Otolaryngology, the researchers examined the impact of a history of tobacco use on the development of CRS.

“This study was inspired by what I felt was a knowledge gap in the literature surrounding a question that we, as ENTs, get asked by
our patients,” Dr. Gill explained. “I wanted to understand whether a history of tobacco use impacted the risk for having chronic sinus disease.”

The researchers employed a case-control study design, using the Utah Population Database to search for adult patients with a diagnosis of CRS and a history of tobacco use. Enrolled patients also underwent endoscopic sinus surgery (ESS) between 1996 and 2018.

Tobacco Use Increases Risk for CRS

Dr. Gill and colleagues examined records for 200,370 patients in the final analysis, including 34,350 patients diagnosed with CRS and 166,020 controls.

The first diagnosis of CRS was made at a mean age of 43.9, and the percentage of patients with CRS with nasal polyposis was 58.3%. A history of tobacco use was observed in a significantly larger number of patients with CRS (19.6%) than in the matched controls (15%; P<0.001).

The correlation between a history of tobacco use and a CRS diagnosis was observed in both males and females and in patients with CRS with and without nasal polyposis (Table). The unadjusted OR for the risk for CRS in patients with a history of tobacco use was 1.38 (P<0.001).

More patients with CRS and comorbid asthma used tobacco (19.5%) compared with controls with asthma (15.0%; P<0.001).

“A history of tobacco use may signify an increased risk for the development of chronic sinus disease among patients undergoing sinus surgery compared with healthy controls,” Dr. Gill emphasized. “In a separate study, we found that a history of tobacco use may also increase the likelihood of needing revision sinus surgery.”

Role of Tobacco Cessation for Patients & Research

The results “emphasize the direct impact and relevance of tobacco use on patients with sinus disease,” Dr. Gill noted. “Providers can consider using the data to help educate patients on the relationship between tobacco and sinus disease and encourage and discuss tobacco cessation with them.”

He also pointed to areas of research interest. “Future research should focus on understanding whether tobacco cessation can positively impact sinus disease severity and symptoms.”

Beyond the impact of tobacco use, Dr. Gill noted that “there has been an increasing interest in the role of environmental pollutants and irritants on nasal and sinus inflammation, and I am hopeful this will yield novel insights into mitigation strategies as we learn more about how these irritants impact the health of our sinuses and nose.”