Impact of tobacco smoke on chronic rhinosinusitis: a review of the literature

Background: Environmental factors such as inhaled pollutants like cigarette smoke may play a significant role in diseases of the upper airway including chronic rhinosinusitis (CRS). The objectives of this review are to summarize prior studies that describe the correlation between active smoking and secondhand smoke (SHS) on CRS. We also review the pathophysiologic effects of cigarette smoke on sinonasal mucosa and discuss its impact on surgical outcomes of endoscopic sinus surgery (ESS). Methods: A literature search was conducted of the PubMed database using the terms sinusitis or rhinosinusitis and smoking. Additional search terms of nasal epithelial and smoke were used to find articles that discussed pathophysiologic effects of tobacco smoke, whereas secondhand smoke was added to identify articles analyzing the correlation of SHS and CRS. Finally endoscopic sinus surgery and outcomes were linked to smoking to find articles that analyzed the impact of smoking on surgical results. Results: We identified 204 articles in the initial search. An additional 72 articles were reviewed for their relevance to the pathophysiologic effects of tobacco smoke while 31 articles were analyzed to determine the correlation of SHS and CRS. Twenty-nine articles were reviewed to analyze the impact of smoking on surgical results. Conclusion: There is clear evidence in the literature that cigarette smoke, either through active smoking or passive exposure to SHS, contributes to CRS. Recent prospective studies suggest that active smoking is not a contraindication to ESS, whereas the impact of smoking volume and long-term smoking after ESS has not been sufficiently evaluated.