Viruses in chronic rhinosinusitis: a systematic review

Area of Science:

• Otolaryngology
• Virology
• Immunology

Background:

• The role of viruses in chronic rhinosinusitis (CRS) is not well understood, unlike in acute rhinosinusitis.
• Viruses may contribute to the initiation, exacerbation, or chronic inflammation of the sinonasal mucosa in CRS.

Purpose of the Study:

• To systematically review the literature on the role of viruses in chronic rhinosinusitis.
• To characterize if viruses are part of the sinonasal microbiome, colonizers, or pathogens in CRS.

Main Methods:

• A systematic review of the English literature was conducted using Ovid Medline, Embase, Scopus, and Web of Science databases.
• Searches included terms such as "viruses," "sinusitis," "rhinovirus," and "chronic rhinosinusitis," updated through September 2023.

Main Results:

• Thirty studies met inclusion criteria, analyzing virus prevalence, host susceptibility, and pathological pathways in CRS.
• Viruses, particularly rhinovirus, were more prevalent in CRS subjects than controls.
• Viral presence was linked to sinonasal hyper-responsiveness, increased bacterial susceptibility, immune gene upregulation, airway remodeling, and worse symptom severity.

Conclusions:

• While viruses appear more prevalent in CRS patients, their precise role in CRS pathophysiology remains unclear.
• Large, longitudinal studies with standardized sampling are required to definitively determine the role of viruses in CRS.