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The pathophysiology is not fully elucidated, but environmental pollutants have been suggested to impact the inflammatory component of the disease process. This review aims to summarize the role of environmental pollution in CRS onset and disease severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines. PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were queried in August 2021. Original articles reporting on air pollution exposure in CRS were included. Other forms of sinonasal disease were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Literature search produced 11,983 articles, of which 10 met inclusion criteria. Outcomes evaluated included incidence\/prevalence, disease severity, quality of life, and histopathologic\/microbial changes. Air pollutant exposure was associated with higher odds of CRS, particularly with particulate matter (PM) exposure. Increasing air pollution exposure was also associated with worsened disease severity and detectable histopathologic changes. Impact on quality of life was less clear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Air pollution (particularly PM) is correlated with CRS incidence\/prevalence and disease severity, with evidence of histopathologic changes in CRS tissue samples. Further research is warranted to better understand the mechanisms by which air pollution components may cause CRS and type 2 inflammation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>3a<\/jats:p><\/jats:sec>","DOI":"10.1002\/lio2.774","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T09:37:33Z","timestamp":1646991453000},"page":"349-360","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":57,"title":["Environmental air pollution and chronic rhinosinusitis: A systematic review"],"prefix":"10.1002","volume":"7","author":[{"given":"Evelyn M.","family":"Leland","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun","family":"Vohra","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella M.","family":"Seal","sequence":"additional","affiliation":[{"name":"Welch Medical Library Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Global Health School of Public Health, Peking University  Beijing China"},{"name":"Institute for Global Health and Development Peking University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7612-9586","authenticated-orcid":false,"suffix":"Jr","given":"Murugappan","family":"Ramanathan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2018.12.986"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0126881"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin19.158"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2016.09.015"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11882-017-0690-5"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25180"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1945892420927244"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2018.10.014"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2012.26.3716"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.4110\/in.2017.17.1.60"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.1986.tb00108.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2012.05.052"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2009.04.045"},{"key":"e_1_2_7_15_1","unstructured":"Agency USEPCriteria air pollutants. 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