The Role, Evaluation, and Effects of Comorbidities in Patients With Chronic Rhinosinusitis.

Abstract

Chronic rhinosinusitis is a prevalent inflammatory airway disease that carries substantial clinical and economic burden and is frequently influenced by coexisting systemic or airway comorbidities. Although chronic rhinosinusitis is often managed as an isolated sinonasal disorder, certain comorbid conditions may alter disease presentation, severity, treatment response, and long-term outcomes, making their recognition clinically important. This review examines the role, evaluation, and effects of common comorbidities in patients with chronic rhinosinusitis, including cystic fibrosis, eosinophilic granulomatosis with polyangiitis, granulomatosis with polyangiitis, immunodeficiency, and bronchiectasis. For each condition, we emphasize when clinicians should suspect an underlying comorbidity, the clinical features, and diagnostic pathways that can help distinguish these entities from typical chronic rhinosinusitis. This review additionally aims to summarize the implications for management including considerations for multidisciplinary care. Recognizing these comorbidities can refine disease classification, explain refractory or atypical disease, and guide more personalized treatment strategies. Improved identification of chronic rhinosinusitis-associated comorbidities may ultimately reduce diagnostic delay, improve patient outcomes, and help define future research priorities to advance care for patients with chronic rhinosinusitis.