Clin Exp Otorhinolaryngol.  2022 Nov;15(4):310-318. 10.21053/ceo.2022.01004.

The Role of Viruses in the Inception of Chronic Rhinosinusitis

• Lee HS
• Volpe SJ
• Chang EH

• KMID: 2536529
• DOI: http://doi.org/10.21053/ceo.2022.01004

Abstract

Chronic rhinosinusitis (CRS) is a complex inflammatory disorder that affects between 2% and 16% of adults in the United States, with estimated healthcare costs between 4 and 12 million USD. Viruses are a common etiologic factor for URIs, are frequently identified in the sinuses of patients with CRS, and trigger CRS exacerbations. Therefore, investigating the role of viruses provides an opportunity to identify their role in the pathogenesis of CRS. In this review, we identified the viruses frequently isolated in patients with CRS, as well as their associated immunologic responses and contributions to inflammation. Rhinovirus, parainfluenza virus, influenza virus, and respiratory syncytial virus are the viruses commonly found in patients with CRS. This information allows us to target pathways early in the pathogenesis of CRS, thereby playing a significant role in slowing the progression of this chronic disease.

Figure

• 

  Fig. 1. As a virus infects the upper airway epithelial cells, it activates Toll-like receptor 7 (TLR7) and retinoic acid-inducible gene I (RIG-1). These receptors induce the release of type I and type III interferons (IFNs), as well as interleukin (IL)-6 and IL-8 and other cytokines, to promote a Th1 immune response. A Th2 immune response is also induced through the production of IL-4, IL-5, IL-13, and other cytokines. The immune response creates inflammation and airway remodeling. Prolonged inflammation results in airway remodeling, which contributes to chronic rhinosinusitis (CRS) due to disrupted epithelial barrier function. As the epithelium is weak and damaged, viral susceptibility increases, resulting in further CRS and upper respiratory disease exacerbations. Additionally, the environment that results from this immune response also creates a suitable environment for bacterial infection, as the epithelial barrier is weak [28,34,43-45,61,62]. The figure was created with BioRender.com.

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