(1) Maytham Lafta Kareem (2)Witwit Uday H.K.AL-Janabi

Abstract :

Chronic rhinosinusitis (CRS) is a chronic inflammatory disorder of the sinonasal mucosa characterized by dysfunctional epithelial clearance systems, defective mucociliary clearance, and chronic immune activation that have a great impact on quality of life and morbidity. The rising global use of e-cigarettes, especially among adolescents and young adults, creates concern for their role in the pathogenesis of CRS. This review presents experimental, clinical, and epidemiological evidence linking vaping exposure with CRS onset and severity. E-cigarette aerosols injure sinonasal epithelial cells by oxidative stress, mitochondrial damage, and disruption of critical tight junctions, leading to increased mucosal permeability and chronic inflammation. Increased mucus secretion and reduced ciliary function lead to impaired mucociliary clearance, ultimately encouraging pathogen colonization and recurrent infections. In addition, reactive oxygen species prime the signaling pathways of inflammation, such as NF-κB, worsening any damage of tissues. Immune dysregulation characterized by altered cytokine expression, impaired macrophage function, and neutrophilic-eosinophilic inflammation amplifies chronic mucosal inflammation. Alterations within the microbiome may serve to perpetuate chronic infection and diminished treatment response. Clinical evidence has found that e-cigarette users have greater symptomatology of CRS in terms of amount and severity, with more severe endoscopic and radiological signals than non-users. Current evidence suggests a biologically plausible relationship between e-cigarette use and the development of CRS; however, further long-term studies are necessary to establish a cause and effect relationship between the two and to develop prevention strategies.