Association of laryngopharyngeal reflux with chronic rhinosinusitis prevalence in adults: A systematic review and meta-analysis

Laryngopharyngeal reflux (LPR) has been implicated in the pathogenesis of chronic rhinosinusitis (CRS), but the evidence from individual studies remains inconsistent. This meta-analysis aims to clarify the association between LPR and CRS in adults. We systematically searched PubMed, Embase, Web of Science, CNKI, and Wanfang for observational studies that evaluate the relationship between LPR and CRS in adult populations. Heterogeneity among studies was assessed using the Cochrane Q test and the I² statistic. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using a random-effects model to account for heterogeneity. A total of eight cross- sectional studies involving 3,456 participants were included in the analysis. The results indicated a significant association between LPR and a higher prevalence of CRS in adults (OR = 4.77, 95% CI 2.51 to 9.07; p < 0.001; I² = 63%). Sensitivity analysis restricted to high-quality studies (Newcastle-Ottawa Scale score ≥ 7) produced similar results with no observed heterogeneity (OR = 5.98, 95% CI 3.60 to 9.92; I² = 0%). Exploratory subgroup analyses suggested a stronger association in studies with smaller sample sizes and when both LPR and CRS were diagnosed using objective methods. No significant evidence of publication bias was detected through Egger's test (p = 0.35); however, this analysis was underpowered and should be interpreted cautiously in the context of the small-study effect. In conclusion, LPR may be associated with an increased prevalence of CRS in adults, especially when both conditions are diagnosed using objective criteria. Further prospective studies are needed to confirm this association and explore the underlying mechanisms.