The Epidemiology, Risk Factors, and Treatment Outcomes of Chronic Rhinosinusitis in Urban and Rural Populations of Lahore

Objective: To investigate the epidemiology, risk factors, and treatment outcomes of chronic rhinosinusitis among urban and rural populations in Lahore, Pakistan, with a focus on allergic conditions, environmental exposures, and treatment adherence. Methodology: A prospective case-control study was conducted at Shalamar Institute of Health Sciences, Lahore, Pakistan, from January to June 2024. A total of 87 adults diagnosed with chronic rhinosinusitis (CRS), age and sex-matched controls were included. CRS diagnosis was confirmed using standard diagnostic criteria. Data was collected through structured validated symptoms and quality-of-life questionnaires, endoscopic and radiological assessments, and systematic documentation. Results: CRS was found to be significantly associated with allergic rhinitis (odds ratio [OR] 3.21, 95% confidence intervals [CI] 1.42–7.24, p=0.004) and poor treatment adherence (OR 2.74, 95% CI 1.22–6.17, p=0.015). Patients with CRS had higher mean SNOT-22 scores (44.3±6.5) than controls (42.3?±?9.9), and significantly higher RSDI scores (49.6±14.0 vs 36.0±8.2; p<0.001). General health-related quality of life was significantly lower in CRS cases (SF-36: 52.6±14.4) than in controls (64.2±14.5; p<0.001). Among CRS patients, urban residents reported a higher symptom burden (SNOT-22: 66.0±13.2 vs 53.2±5.7, p=0.001) and lower SF-36 scores (52.6±14.4 vs 64.2±14.5, p=0.002) than rural residents, although objective disease scores (Lund-Kennedy and Lund-Mackay) showed no significant urban–rural differences. Conclusion: Allergic comorbidity and poor compliance are found to be main factors contributing to symptom burden and impaired quality of life in patients with CRS in Lahore, Pakistan. Integrated management strategies that address allergy control, adherence, and environmental risk assessment may optimize patient outcomes across versatile communities.