- Design
- Systematic review and meta-analysis, PRISMA reported, search to July 2025
- Population
- 3685 adults across 17 studies treated for head and neck cancer
- Primary outcome
- Incidence of and risk factors for chronic rhinosinusitis after treatment
- Effect
- Pooled incidence 0.37 (95 per cent CI 0.27 to 0.47); 0.45 after nasopharyngeal carcinoma vs 0.18 other sites; radiotherapy log OR 1.46 (0.76 to 2.16)
Seventeen studies and 3685 adults treated for head and neck cancer were pooled to establish how often chronic rhinosinusitis develops afterwards. The overall pooled incidence was 0.37 (95 per cent CI 0.27 to 0.47). It was far from evenly spread: 0.45 after nasopharyngeal carcinoma against 0.18 for other primary sites (P < 0.001). The maxillary sinuses were involved most often, in 0.60 of affected patients, then the ethmoids at 0.45.
Radiotherapy was the identified driver, with a log odds ratio of 1.46 (95 per cent CI 0.76 to 2.16) - about a fourfold increase in the odds - and the effect was much larger in nasopharyngeal disease than elsewhere (log odds ratio 1.82 against 0.52, P = 0.01). Qualitative review added concurrent chemotherapy and advanced stage as further risks.
The number is high enough to change what happens at follow-up. Survivorship clinics are built around recurrence surveillance, swallowing and neck function, and sinonasal symptoms in a patient who has had radiotherapy are easily filed as expected dryness and crusting. If more than one in three of these patients meets criteria for chronic rhinosinusitis, they should be asked about it explicitly and treated for it, not managed as an inevitability. That matters particularly in India, where nasopharyngeal carcinoma is concentrated in the north-eastern states and the treated population is younger than the global average, so the symptomatic years after cure are many.
- Ask directly about nasal obstruction, discharge and facial pressure at every post-radiotherapy follow-up.
- Expect maxillary and ethmoid involvement; these are the sinuses to look at on the surveillance imaging you already have.
- Flag nasopharyngeal primaries as the highest-risk group and follow them accordingly.
- Treat post-radiation chronic rhinosinusitis actively rather than describing it as expected treatment effect.
- Note that the studies defined chronic rhinosinusitis inconsistently, so use your own diagnostic criteria rather than the pooled label.
The statistics, in plain English
A log odds ratio of 1.46 means the odds multiply by about 4.3; the interval from 0.76 to 2.16 translates to roughly 2.1 to 8.7, so the direction is certain and the size is not. The authors flag significant heterogeneity in how chronic rhinosinusitis was diagnosed across the 17 studies, which is why the pooled incidence carries a wide interval and why a single centre's rate may differ substantially. These are incidences after treatment, not risks attributable to it, since none of the pooled studies had an untreated comparator.
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