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However, there is no difference in LM between the 2 groups. At higher levels of pollutant exposure (ie, > 30%), there is a trend demonstrating increasing prevalence of CRSsNP.

Both groups had similar exposure to air pollutants. CRSsNP cohort with PM exposure is significantly more likely to require ESS and revision ESS in a dose dependent relationship ( p = 0.015). BC exposure is predictive of significantly worse SNOT 22 scores ( p = 0.008). These

levels > 30% of VGDFFiM compared to CRSwNP and AERD ( p = 0.03). Exposed patients require significantly more systemic steroids ( p = 0.015 and p = 0.03, respectively) and are more likely to require ESS ( p = 0.04) than controls.

Occupational exposure to metal and paper dust, cleaning agents, animals, moisture/mold/mildew, and physical labor is independently associated with CRS.

significant trends are not seen in the CRSwNP cohort.

There appears to be an association between prevalence of CRS and smoking status, low SES, and living/working environment with pollutant exposure. Heterogeneity of

defining CRS across the investigations that were included in this review limits the interpretation of the results.

TABLE IX-24 Evidence for environmental triggers as a contributing factor for CRS Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Velasquez 1039 2020 4 Case series (n = 234) CRSwNP (n = 113), CRSsNP (n = 96), AERD(n = 25) Impact of exposure to airborne vapors, gases, dusts, fumes fibers, mists (VGDFFiM) or diesel fumes on sinonasal disease severity as measured by LM, systemic steroids, need of ESS. Patient’s with CRSsNP had a significantly higher exposure to Clarhed 1029 2018 4 Cross-sectional (n = 16,099) Random sample population in Telemark, Norway was surveyed (n = Prevalence of CRS and occupational exposure (self-identified on survey).

Impact of air pollutants (PM and BC) on sinonasal disease

severity as measured by SNOT 22, LM,

systemic steroids, number of ESS

CRS, which is variably

defined in the included studies, and SES, education level, drug/toxin use,

smoking status,

diet/exercise, family life, and living/working environment.

Association between

CRSwNP (n = 138)

Mady 1038 2018 4 Case series (n = 234) CRSsNP (n = 96),

48,142). CRS defined according to EPOS criteria.

living/working environment

conditions, 14 use of

toxins/drugs, 11 SES, 5 diet/exercise, 1

family/martial status)

Geramas 1041 2018 3 Systematic review 30 studies (12