Incidence and Risks of Chronic Rhinosinusitis in Head and Neck Cancer: A Meta-Analysis.

Abstract

Several studies have described the occurrence of chronic rhinosinusitis (CRS) in adult patients with head and neck cancers (HNC). The goal of this review is to identify the incidence and risk factors for CRS in adult patients with HNC. PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials. A systematic search was performed from inception to July 2025 and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Studies that looked at the development of CRS following treatment of HNC were included. Seventeen studies representing a total of 3685 patients were pooled. There was significant heterogeneity in how CRS was diagnosed. The overall pooled incidence of CRS in all HNC patients was 0.37 (95% CI, 0.27-0.47). The incidence was significantly higher in patients with nasopharyngeal cancer (NPC) (0.45 vs. 0.18, p < 0.001). The maxillary sinuses were the most common sinuses involved with an incidence of 0.60 followed by the ethmoid sinuses at 0.45. Radiation therapy was associated with a higher risk of CRS (log OR = 1.46, 95% CI of 0.76, 2.16), especially in patients with NPC (log OR of 1.82 vs. log OR of 0.52, p = 0.01). Qualitative review showed that concurrent chemotherapy and advanced disease stage also increased the risk of CRS. The presence of NPC, radiation therapy, advanced stage, and concurrent chemotherapy significantly increases the risk of CRS in patients with head and neck cancers. Clinicians should be aware of the risk when treating these patients.