Evidence map›Paper›PMID 18786300›Full record

ReviewAmerican journal of rhinology

Perspectives on the etiology of chronic rhinosinusitis: an immune barrier hypothesis.

Robert C Kern, David B Conley, William Walsh, Rakesh Chandra, Atsushi Kato, Anju Tripathi-Peters, Leslie C Grammer, Robert P Schleimer

Open access · greenAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in American journal of rhinology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 118 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
118citing papers in PubMed, 11 pooled it
6.2field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

118 citing papers in PubMed, 11 syntheses or guidelines pooled it, 319 citations in OpenAlex.

  1. Biologics for chronic rhinosinusitis.The Cochrane database of systematic reviews · 2021
    Pooled it
  2. Biologics for chronic rhinosinusitis.The Cochrane database of systematic reviews · 2020
    Pooled it
  3. Topical and systemic antifungal therapy for chronic rhinosinusitis.The Cochrane database of systematic reviews · 2018
    Pooled it
  4. Pooled it
  5. Short-course oral steroids alone for chronic rhinosinusitis.The Cochrane database of systematic reviews · 2016
    Pooled it
  6. Systemic and topical antibiotics for chronic rhinosinusitis.The Cochrane database of systematic reviews · 2016
    Pooled it
  7. Different types of intranasal steroids for chronic rhinosinusitis.The Cochrane database of systematic reviews · 2016
    Pooled it
  8. Short-course oral steroids as an adjunct therapy for chronic rhinosinusitis.The Cochrane database of systematic reviews · 2016
    Pooled it
  9. Saline irrigation for chronic rhinosinusitis.The Cochrane database of systematic reviews · 2016
    Pooled it
  10. Pooled it
  11. Guideline
  12. Trial
  13. Trial
  14. Trial
  15. Article
  16. Journal of bacteriology · 2025
    Article
  17. Review
  18. Article
  19. Review
  20. Review

58 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

Robert C KernDepartment of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. r-kern@northwestern.edu
David B Conley
William Walsh
Rakesh Chandra
Atsushi Kato
Anju Tripathi-Peters
Leslie C Grammer
Robert P Schleimer
Northwestern University · US

Funding

Role of Epithelium in Immunity, Inflammation and DiseaseR01HL078860 · NHLBI · NORTHWESTERN UNIVERSITY AT CHICAGO · PI SCHLEIMER, ROBERT P · 2006 to 2013
$3.0M
Epithelial BAFF and APRIL in Airway Inflammation, Immunity and DiseaseR01AI072570 · NIAID · NORTHWESTERN UNIVERSITY AT CHICAGO · PI SCHLEIMER, ROBERT P · 2007 to 2011
$2.3M
NHLBI NIH HHS R01 HL078860NIAID NIH HHS R01 AI072570
6 · The paper itself

Abstract

backgroundChronic rhinosinusitis (CRS) has been defined as persistent symptomatic inflammation of the nasal and sinus mucosa resulting from the interaction of multiple host and environmental factors. Recent studies have implicated Alternaria fungi or toxigenic Staphylococcus aureus as critical agents in CRS pathogenesis. The emphasis on environmental agents in CRS etiology has focused interest toward elimination of those agents as the prime mechanism of therapy. This viewpoint is in marked contrast to the current perspective on some other chronic inflammatory epithelial disorders that afflict the skin, lungs, and gut, wherein host factors are believed to predispose to disease expression in the presence of ubiquitous environmental agents.

methodsThe current review evaluates CRS etiology from this perspective and considers that CRS develops, in part, as an outcome of a dysfunctional host response. Specifically, evidence from our laboratory and others will be reviewed indicating that CRS is associated with a failure of the mechanical and immunologic barriers across the nasal mucosa. The hypothesis would further propose that genetic and epigenetic variation predisposes susceptible individuals to barrier failure in the presence of environmental stress leading to CRS.

resultsFrom this unifying perspective, bacteria and fungi are seen as disease modifiers rather than primary etiologic agents.

conclusionThe goal is to place concepts of CRS pathophysiology in a framework consistent with a current understanding of chronic inflammation in general and epithelial disease in particular.

Indexed as

AlternariaChronic DiseaseHumansNasal MucosaRhinitisSinusitisSuperantigensSuperantigens

Identifiers

PMID18786300
PMCPMC2802263
OpenAlexW1999233686

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.