The Impact of Chronic Particulate Matter Exposure on Quality-of-Life Outcomes after ESS

Clinical Question

Does chronic pre-operative exposure to fine particulate matter (PM2.5) affect quality-of-life (QoL) outcomes after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS)?

Bottom Line

Higher pre-operative PM2.5 exposure is associated with reduced post-operative QoL improvement in patients with CRS with nasal polyps (CRSwNP), particularly in psychological and sleep subdomains, while no significant association is observed in CRS without nasal polyps (CRSsNP).

Background: Chronic rhinosinusitis is a prevalent inflammatory condition, with increasing evidence linking environmental pollutants—particularly fine particulate matter (PM2.5)—to disease development and severity. While ESS improves QoL, the impact of chronic environmental exposure on post-operative outcomes remains unclear.

Study Design: Prospective observational cohort study of CRS patients undergoing ESS with more than six months of follow-up. Pre-operative PM2.5 exposure was estimated using geocoded residential data and a validated spatiotemporal PM2.5 exposure model. Multivariate regression assessed associations with Sino-Nasal Outcome Test (SNOT-22) total and subdomain changes.

Setting: Single academic tertiary-care center (Vanderbilt University Medical Center)

Synopsis: A total of 226 patients were included, equally divided between CRSwNP and CRSsNP. Mean pre-operative PM2.5 exposure was 8.2 µg/m³. Overall, patients demonstrated significant improvement in QoL after ESS, with a mean SNOT-22 reduction of 21.4 points, consistent with clinically meaningful improvement.

In CRSwNP patients, higher PM2.5 exposure was significantly associated with less post-operative improvement in total SNOT-22 scores (β = 8.25, p = 0.036). For each 1 µg/m³ increase in 12-month PM2.5 exposure, the magnitude of improvement decreased by approximately 8 points—approaching the minimal clinically important difference of 8.9 points. Subdomain analysis revealed that this effect was primarily driven by psychological (β ≈ 3.7) and sleep (β ≈ 2.6) domains, both nearing clinically meaningful thresholds.

In contrast, no significant associations between 12-month PM2.5 exposure and post-operative QoL outcomes were identified in CRSsNP patients across total or subdomain scores.

The authors suggest that environmental pollutant exposure may contribute to persistent or refractory symptoms, particularly in CRSwNP, and may influence patient expectations and post-operative counseling. Limitations include single-center design, limited geographic variability, potential exposure misclassification, and lack of adjustment for factors such as occupational exposure and smoking.

Citation: Rygalski C, et al. The impact of chronic particulate matter exposure on quality-of-life outcomes after endoscopic sinus surgery. Int Forum Allergy Rhinol. 2025;15:1425-1428. doi:10.1002/alr.70051.

Comment: With increasing particulate levels globally, the implications for CRS and its management are notable. It has been demonstrated that increased PM2.5 is associated with the development of and increased severity of CRS. This study finds that elevated levels of pre-operative exposure are associated with worse outcomes following endoscopic sinus surgery, specifically for those with CRSwNP (the association was not noted in patients with CRSsNP). Interestingly, this difference appeared to be driven by the psychological and sleep subdomains. These findings may be relevant and important when counseling patients on the expectations for a successful outcome, depending on their environment. —Ashoke Khanwalkar, MD