\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[ngerman,english]{babel}



\usepackage{float}








\begin{document}

\title{Prevalence of paranasal sinusitis in adults and its characteristics in
smokers}



\author[1]{tian yuxin}%
\author[1]{zhou huiqun}%
\author[1]{wang jingjing}%
\author[1]{fan liqiang}%
\author[1]{xue wenyue}%
\author[1]{liu yaoqian}%
\author[1]{li yongdong}%
\author[1]{yu dongzhen}%
\author[1]{zhengnong Chen}%
\author[1]{yin shankai}%
\affil[1]{Shanghai Jiao Tong University}%


\vspace{-1em}



  
  \date{June 17, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Background: Paranasal sinusitis is frequently encountered in clinical
practice. The application of imaging techniques has highlighted the high
incidence of incidental sinus abnormalities. Additionally, the adverse
impact of smoking on paranasal sinusitis has been verified; however, few
studies have compared the characteristics of affected sinuses between
non-smokers and smokers. This study aimed to assess the prevalence of
paranasal sinusitis detected by magnetic resonance imaging (MRI) and
determine its characteristics and affected sinuses in smokers. Methods:
This cross-sectional study involved 4813 participants from two
communities in Shanghai, China. Demographic data were recorded, and
participants underwent a physical examination and head MRI. Logistic
regression analysis was used to examine the relationship between smoking
and paranasal sinusitis and the Cochran--Armitage test to analyze
age-specific prevalence of paranasal sinusitis in smokers versus
non-smokers. Results: Among the 4813 participants (2368 men, 2445 women;
mean age, 53.0\selectlanguage{ngerman}±10.1 years), the prevalence of paranasal sinusitis was
15.4 \%, being higher in men (20.1 \%) than in women (10.8 \%;
p\textless{}0.001). Paranasal sinusitis was significantly associated
with smoking (adjusted OR=1.37, 95 \% CI=1.10--1.70), and in smokers, it
occurred most often in the maxillary sinus (19.1 \%), followed by
ethmoid (2.9 \%), frontal (2.2 \%), and sphenoid (1.8 \%) sinuses.
Conclusion: The prevalence of paranasal sinusitis was 15.4 \% in Chinese
adults aged 35--75 years. This gradually increased with age, reaching a
peak at 55 years and stabilizing thereafter. In smokers, sinusitis
occurred more often in the anterior nasal sinuses. (Clinical Trials. gov
number: NCT00926172)%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\textbf{Introduction}

Paranasal sinusitis refers to inflammation of the paranasal sinuses as a
result of either infectious or noninfectious causes, and it is
frequently encountered in clinical practice. Although paranasal
sinusitis is not a life-threatening disease, it can have a substantial
impact on health-related quality of life\textsuperscript{1} and,
concurrently, increase the personal and social economic burden due to
the relatively high cost of treatment\textsuperscript{2, 3}.

On the one hand, according to previous studies, the prevalence and
patterns of sinusitis may vary by region and population and may change
with the course of time~\textsuperscript{4-7}. However, these studies
diagnosed chronic rhinosinusitis (CRS) based on standardized surveys
that may have introduced subjective bias to the results. Additionally,
individuals with asymptomatic sinusitis are likely to be overlooked in
such studies. On the other hand, many population-based studies have
determined smoking to be an important independent risk factor for the
development of CRS \textsuperscript{8-10}. A recent study investigating
37 753 people in Korea found that, for every year of active smoking, the
prevalence of self-reported CRS increases by 1.5 \%\textsuperscript{10}.
However, few studies have compared the epidemiological and clinical
characteristics of sinusitis between smokers and non-smokers. In
addition, because smoking may cause symptoms that are similar to those
of sinusitis, studying the relationship between smoking and sinusitis
from the perspective of symptoms alone is challenging.

Meanwhile, with the application of imaging techniques, the high
incidence of incidental findings of sinus abnormalities across all age
groups has attracted attention~\textsuperscript{11-13}. A recent report
described a case of asymptomatic sinusitis with a potential
glomerulonephritis-related origin \textsuperscript{14}. Previous studies
have confirmed that imaging findings are significantly related to
symptoms presented in patients with paranasal
sinusitis\textsuperscript{15-17}. Compared to computed tomography (CT),
magnetic resonance imaging (MRI) does not use radiation and,
additionally, does not overstage or overclassify patients with sinus
disease\textsuperscript{18}. Therefore, the clinical application of MRI
could provide an ideal method for the objective detection of paranasal
sinusitis in the general population.

We conducted a cross-sectional survey among individuals from two
communities in Shanghai, China. This study aimed to provide objective
and reliable data on the prevalence of paranasal sinusitis detected by
MRI and to determine the effects of smoking on paranasal sinusitis in a
large population.

\textbf{Methods}

\textbf{Study population}

This was a cross-sectional study performed at the Sixth People's
Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.
The participants were randomly selected from two communities in
districts with long-term stable populations~(Pandongli and Jingfenglu),
because the age and sex distribution data were similar to those of the
2007 Shanghai census. In brief, the study population consisted of
participants aged between 35 and 75 years (n=4813) who underwent head
MRI between June 2007 and June 2011. Exclusion criteria included
participants who refused to take part in the study or were not adherent,
as well as those who were not suitable for MRI, such as cases involving
a pacemaker or metallic implant, the early stage of pregnancy, dentures,
or claustrophobia. The study protocol was reviewed and approved by the
ethics committee of the Sixth People's Hospital Affiliated to Shanghai
Jiao Tong University. All participants provided informed consent prior
to study enrollment \textsuperscript{19}.

\textbf{Data collection}

The recording of demographic information, physical examination
(including height, weight, and blood pressure), and head MRI were
performed during a single interview. The following general information
was obtained: age, sex, height, weight, body mass index (BMI), smoking
(defined as having smoked \textgreater{}100 cigarettes in a lifetime),
alcohol consumption~(defined as consuming \textgreater{}30 g of alcohol
per week for one year or longer), hypertension, diabetes,
hyperlipidemia, stroke, coronary heart disease, myocardial infarction,
and arrhythmia \textsuperscript{19}.

\textbf{Paranasal sinusitis}

The MRI signals in the frontal, maxillary, and sphenoid sinuses were
classified as follows \textsuperscript{20}:

0. Absence of signal: normal 1. Visible illumination of the sinus
mucosa, although \textless{}5 mm: normal 2. Thickening of the mucosal
membrane [?]5 mm, although occupying less than 50 \% of the cross-section
of the sinus: pathological 3. The mucosa occupies more than 50 \% of the
cross-sectional area, although the sinus still contains some air:
pathological 4. Total sinus opacification or fluid level: pathological
5. Polyp or retention cyst: a lesion with rounded edges surrounded by
air: pathological 6. Other: anatomic abnormalities presumed to be
attributable to previous nasal or sinus surgery: pathological

The MRI signals in the ethmoid sinuses were classified as
follows\textsuperscript{20}:

0. Absence of signal: normal 1. Minimal or moderate sinus opacification:
normal 4. Marked or total sinus opacification: pathological

Paranasal sinusitis was defined as the presence of abnormal findings in
at least one of the paranasal sinuses detected by head MRI.

\textbf{MRI protocol and image analyses}

Head MRI studies were performed on a 3.0 T system (Achieva X-Series,
Philips Medical Systems, OH, USA) and T2-weighted images were used for
the screening of paranasal sinusitis. All T2-weighted images were
obtained in the axial plane, although, if necessary, sagittal or coronal
images were also obtained. The images were analyzed independently by
three observers, with more than 5 years of work experience in
neuroradiology, who were unaware of the participants' information or the
study's purpose.

\textbf{Statistical analyses}

Statistical analyses were performed using SPSS 25.0 (IBM Corp., Armonk,
NY, USA). In the univariate analyses, the chi-squared test was used to
compare categorical variables, while Student's t-test was used for
continuous variables. Logistic regression analysis was used to assess
the risk factors for paranasal sinusitis. Additionally, the
Cochran--Armitage trend test of SAS 9.4 (SAS Institute, Cary, NC, USA)
was used to analyze the age-specific prevalence of paranasal sinusitis
in smokers and non-smokers. A p-value \textless{}0.05 was considered
statistically significant for all analyses.

\textbf{Results}

Among the 4813 participants who were investigated (2368 men and 2445
women; mean age, 53.1\selectlanguage{ngerman}±10.1 years), paranasal sinusitis was diagnosed in
740 (15.4 \%). Table~1 shows the characteristics of the study
participants with and without paranasal sinusitis. The data show that
sex was significantly associated with the presence of paranasal
sinusitis, together with age, BMI, alcohol consumption, stroke, smoking,
and hypertension.

Logistic regression analysis was performed to examine the risk factors
associated with paranasal sinusitis (Table 2). When adjusted for age and
sex (Model A), alcohol consumption and hypertension were not
significantly associated with paranasal sinusitis. The final model
(Model B) adjusted for all the factors that were found to be
statistically significant in the univariate analysis, including age,
sex, BMI, smoking, alcohol consumption, hypertension, and stroke---only
smoking was significantly associated with the prevalence of paranasal
sinusitis.

The age-specific prevalence of paranasal sinusitis in smokers and
non-smokers is shown in Table 3. For all age groups, the prevalence was
higher in smokers than in non-smokers (Figure 1). The prevalence of
paranasal sinusitis significantly increased with age in non-smoking
individuals, whereas no significant age-specific difference was found
among smokers (trend test, non-smokers p\textless{}0.001; smokers
p=0.499).

Table 4 shows a comparison of the prevalence of sinusitis affecting
different regions between smokers and non-smokers; the anterior nasal
sinuses were more often affected in smokers than in non-smokers, while
no significant difference was found regarding the sphenoid sinus. Among
the total study population, maxillary sinusitis was the most prevalent
(13.4 \%) while the prevalence was 19.1 \% in smokers and 11.7 \% in
non-smokers.

\textbf{Discussion}

The present study investigated the prevalence of paranasal sinusitis,
diagnosed using MRI, among a community population from Shanghai, China.
Additionally, the epidemiological and clinical characteristics of
sinusitis between smokers and non-smokers were investigated. Overall,
the prevalence of paranasal sinusitis was found to be 15.4 \% in adults
aged 35--75 years. This prevalence increased concurrently with age, from
12.6 \% (35--44 years) to 16.5 \% (55--75 years); a peak was reached at
55 years, stabilizing thereafter. The Cochran--Armitage trend test
further showed that there was a positive correlation between age and
paranasal sinusitis in non-smokers, while the prevalence in smokers
remained consistently high, at more than 20 \% in each age group.
Moreover, it was found that paranasal sinusitis more often involved the
anterior nasal sinuses in smokers than in non-smokers.

In China, the first large-scale investigation concerning the
epidemiology of CRS was reported in 2015. This investigation estimated a
CRS prevalence of 8.0 \% in the entire population and 8.2 \% among
adults aged 15--75 years \textsuperscript{21}, which was lower than the
prevalence noted in the present study. This difference may be explained
as follows: The previous study diagnosed CRS based on the results from a
standardized questionnaire, whereas this study employed MRI for this
purpose. The former method of diagnosis may result in some patients with
unobvious symptoms being overlooked, while the latter is not able to
distinguish the course or type of sinusitis effectively. Havas et al.
reported abnormal CT and MRI findings of the paranasal sinuses in
asymptomatic adults to be as high as 42.5 \% \textsuperscript{13}. Kim
et al. further confirmed that the prevalence and risk factors of CRS
differed rather substantially when using different criteria, even in the
same population\textsuperscript{22}. Because of this difference, the
investigation from 2015 may have underestimated the prevalence.

Compared to other studies that diagnosed paranasal sinusitis by means of
MRI, the prevalence noted in our study was lower than that noted in
studies from Denmark (31.7 \%) \textsuperscript{20}, Japan (33.8
\%)\textsuperscript{23}, and Norway (66 \%) \textsuperscript{12}. We
believe that this variation could be due to the use of different
diagnostic criteria and research techniques. Additionally, the
prevalence of paranasal sinusitis is influenced by climate and race,
being more likely to occur in colder climates and in people who are
white \textsuperscript{24-26}. That said, in Japan, a Lund--Mackay score
\selectlanguage{english}[?]4 was classified as an MRI abnormality that was suspected as sinusitis,
whereas in Norway, opacifications that indicated mucosal thickenings,
polyps, retention cysts, or fluid were recorded when measuring
\textgreater{}1~mm. In our study, however, mucosal thickening of \selectlanguage{english}[?]5 mm
was used as an indication of paranasal sinusitis, as per the Danish
diagnostic criteria. By choosing a relatively high cut-off value,
challenges regarding overdiagnosis due to the high sensitivity of MRI
can be overcome, ensuring more accurate findings \textsuperscript{20}.

Among all the participants in this study, 49.2 \% were men. We found
that men were approximately 86 \% more likely to have paranasal
sinusitis than women (adjusted OR = 1.86, 95 \% CI = 1.54--2.24), which
is consistent with the results of studies from Asia \textsuperscript{21,
23, 27}. However, some surveys from developed Western countries found
that women were at a higher risk of developing paranasal
sinusitis\textsuperscript{6, 9, 28}. This discrepancy may be related to
differences in the living habits and level of awareness of paranasal
sinusitis between populations from Eastern and Western countries.

At present, the relationship between the prevalence of paranasal
sinusitis and age is somewhat controversial. In a previous study, Chen
et al. found that the prevalence of CRS in Canadians older than 12 years
increased with age, reaching a plateau after the age of 60
years\textsuperscript{28}. Additionally, Hirsch et al. found that the
prevalence of CRS peaked at 15.9 \% between the ages of 50 and 59 years,
subsequently dropping to 6.8 \% after age 69 \textsuperscript{24}, while
Shi et al. found a higher prevalence in individuals aged 15--34
years\textsuperscript{21}. In our study, we found that the overall
prevalence of paranasal sinusitis in adults aged 35--75 years increased
with age, reaching a peak at 55 years of age and stabilizing thereafter.
The prevalence of paranasal sinusitis was found to have a strong
positive correlation with age, particularly among non-smokers. This may
be related to certain changes in the nasal anatomy and physiology that
occurs with aging, such as reduced mucosal blood flow and impaired
mucociliary function \textsuperscript{29}.

It is well known that smoking is closely related to respiratory
diseases. Literature shows that tobacco smoke can adversely affect
sinonasal mucociliary clearance, innate immune function, and olfactory
mucosal metaplasia \textsuperscript{8}. Several clinical studies have
confirmed that there is a correlation between smoking and paranasal
sinusitis in the Asian population \textsuperscript{8, 10, 30}. Our
research confirmed these findings, in that smoking is one of the
significant independent risk factors in the development of paranasal
sinusitis.

The location of paranasal sinusitis differs depending on its etiology.
In contrast to the abundant literature regarding the correlation between
smoking and paranasal sinusitis, there are relatively few studies
assessing its most prevalent location. Interestingly, we found that in
smokers, paranasal sinusitis more commonly occurs in the anterior nasal
sinuses than in non-smokers, where it occurs most often in the maxillary
sinus, followed by the ethmoid, frontal, and sphenoid sinuses. In
smokers, the most common sites of sinusitis were found to be the
maxillary sinus, followed by the sphenoid, frontal, and ethmoid sinuses.
Kjaergaard et al. demonstrated that smokers have lower nasal cavity
volumes and smaller minimum cross-sectional areas, achieve lower peak
nasal inspiratory flow rates, and have a lower decongestive capacity of
the nasal mucosa \textsuperscript{31}. Hence, we speculate that these
nasal changes brought about by smoking are more likely to affect the
mucociliary clearance movement and ventilation of the anterior nasal
sinuses that open in the middle nasal passage. More research is needed
to support this hypothesis.

\textbf{Limitations}

Several limitations of the present study should be mentioned. Firstly,
paranasal sinusitis was diagnosed by MRI, which lacks a description of
the patient's subjective symptoms. Although patients with asymptomatic
sinusitis can be overlooked, there is the additional possibility of
overdiagnosis due to the sensitivity of MRI. Furthermore, we could not
distinguish between acute and chronic sinusitis. Future studies should
evaluate the prevalence of paranasal sinusitis in the general population
using a combination of MRI and/or CT and the relevant symptoms.
Secondly, CT is superior to MRI for the examination of anatomical bone
variations, which is an important risk factor for paranasal
sinusitis\textsuperscript{32}. Lastly, paranasal sinusitis in children
is also a common problem \textsuperscript{33}; however, our research
participants were limited to individuals aged 35--75 years due to
factors such as cooperation. Therefore, the findings may not be
applicable to the general population.

\textbf{Conclusion}

In conclusion, this study found that the overall prevalence of paranasal
sinusitis in Chinese adults aged 35--75 years is 15.4 \%. The major risk
factors for paranasal sinusitis include age, sex, and smoking. In
non-smokers, the prevalence of paranasal sinusitis increases with age,
while in smokers, sinusitis more often involves the anterior nasal
sinuses. These results may facilitate the understanding of the
epidemiology of paranasal sinusitis detected by MRI and prove valuable
in the prevention and treatment of paranasal sinusitis.

\textbf{{[}References{]}}

1. Erskine, S. E.; Hopkins, C.; Clark, A.; Anari, S.; Robertson, A.;
Sunkaraneni, S.; Wilson, J. A.; Beezhold, J.; Philpott, C. M., Chronic
rhinosinusitis and mood disturbance. \emph{Rhinology}
\textbf{2017,}\emph{55} (2), 113-119.

2. Wahid, N. W.; Smith, R.; Clark, A.; Salam, M.; Philpott, C. M., The
socioeconomic cost of chronic rhinosinusitis study.
\emph{Rhinology}\textbf{2020,} \emph{58} (2), 112-125.

3. Yip, J.; Vescan, A. D.; Witterick, I. J.; Monteiro, E., The personal
financial burden of chronic rhinosinusitis: A Canadian
perspective.\emph{Am J Rhinol Allergy} \textbf{2017,} \emph{31} (4),
216-221.

4. Xu, Y.; Quan, H.; Faris, P.; Garies, S.; Liu, M.; Bird, C.; Kukec,
E.; Dean, S.; Rudmik, L., Prevalence and Incidence of Diagnosed Chronic
Rhinosinusitis in Alberta, Canada. \emph{JAMA Otolaryngol Head Neck
Surg} \textbf{2016,} \emph{142} (11), 1063-1069.

5. Pleis, J. R.; Lethbridge-Cejku, M., Summary health statistics for
U.S. adults: National Health Interview Survey, 2006. \emph{Vital Health
Stat 10} \textbf{2007,} (235), 1-153.

6. Blackwell, D. L.; Lucas, J. W.; Clarke, T. C., Summary health
statistics for U.S. adults: national health interview survey,
2012.\emph{Vital Health Stat 10} \textbf{2014,} (260), 1-161.

7. Pilan, R. R.; Pinna, F. R.; Bezerra, T. F.; Mori, R. L.; Padua, F.
G.; Bento, R. F.; Perez-Novo, C.; Bachert, C.; Voegels, R. L.,
Prevalence of chronic rhinosinusitis in Sao Paulo.
\emph{Rhinology}\textbf{2012,} \emph{50} (2), 129-38.

8. Reh, D. D.; Higgins, T. S.; Smith, T. L., Impact of tobacco smoke on
chronic rhinosinusitis: a review of the literature. \emph{Int Forum
Allergy Rhinol} \textbf{2012,} \emph{2} (5), 362-9.

9. Hastan, D.; Fokkens, W. J.; Bachert, C.; Newson, R. B.; Bislimovska,
J.; Bockelbrink, A.; Bousquet, P. J.; Brozek, G.; Bruno, A.; Dahlen, S.
E.; Forsberg, B.; Gunnbjornsdottir, M.; Kasper, L.; Kramer, U.;
Kowalski, M. L.; Lange, B.; Lundback, B.; Salagean, E.; Todo-Bom, A.;
Tomassen, P.; Toskala, E.; van Drunen, C. M.; Bousquet, J.; Zuberbier,
T.; Jarvis, D.; Burney, P., Chronic rhinosinusitis in Europe--an
underestimated disease. A GA(2)LEN study. \emph{Allergy}
\textbf{2011,}\emph{66} (9), 1216-23.

10. Lee, W. H.; Hong, S. N.; Kim, H. J.; Ahn, S.; Rhee, C. S.; Lee, C.
H.; Kim, J. W., Effects of cigarette smoking on rhinologic diseases:
Korean National Health and Nutrition Examination Survey
2008-2011.\emph{Int Forum Allergy Rhinol} \textbf{2015,} \emph{5} (10),
937-43.

11. Lim, W. K.; Ram, B.; Fasulakis, S.; Kane, K. J., Incidental magnetic
resonance image sinus abnormalities in asymptomatic Australian
children.\emph{J Laryngol Otol} \textbf{2003,} \emph{117} (12), 969-72.

12. Hansen, A. G.; Helvik, A. S.; Nordgard, S.; Bugten, V.; Stovner, L.
J.; Haberg, A. K.; Garseth, M.; Eggesbo, H. B., Incidental findings in
MRI of the paranasal sinuses in adults: a population-based study (HUNT
MRI). \emph{BMC Ear Nose Throat Disord} \textbf{2014,} \emph{14} (1),
13.

13. Havas, T. E.; Motbey, J. A.; Gullane, P. J., Prevalence of
incidental abnormalities on computed tomographic scans of the paranasal
sinuses. \emph{Arch Otolaryngol Head Neck Surg} \textbf{1988,}\emph{114}
(8), 856-9.

14. Noda, S.; Mandai, S.; Oda, T.; Shinoto, T.; Sato, H.; Sato, K.;
Hirokawa, K.; Noda, Y.; Uchida, S., Asymptomatic sinusitis as an origin
of infection-related glomerulonephritis manifesting steroid-resistant
nephrotic syndrome: A case report. \emph{Medicine
(Baltimore)}\textbf{2020,} \emph{99} (25), e20572.

15. Nazri, M.; Bux, S. I.; Tengku-Kamalden, T. F.; Ng, K. H.; Sun, Z.,
Incidental detection of sinus mucosal abnormalities on CT and MRI
imaging of the head. \emph{Quant Imaging Med Surg}
\textbf{2013,}\emph{3} (2), 82-8.

16. Nair, S., Correlation between symptoms and radiological findings in
patients of chronic rhinosinusitis: a modified radiological typing
system. \emph{Rhinology} \textbf{2009,} \emph{47} (2), 181-6.

17. Nangia, S.; Giridher, V.; Chawla, P., Evaluation of the Role of
Nasal Endoscopy and Computed Tomography Individually in the Diagnosis of
Chronic Rhinosinusitis. \emph{Indian J Otolaryngol Head Neck
Surg}\textbf{2019,} \emph{71} (Suppl 3), 1711-1717.

18. Lin, H. W.; Bhattacharyya, N., Diagnostic and staging accuracy of
magnetic resonance imaging for the assessment of sinonasal
disease.\emph{Am J Rhinol Allergy} \textbf{2009,} \emph{23} (1), 36-9.

19. Li, M. H.; Chen, S. W.; Li, Y. D.; Chen, Y. C.; Cheng, Y. S.; Hu, D.
J.; Tan, H. Q.; Wu, Q.; Wang, W.; Sun, Z. K.; Wei, X. E.; Zhang, J. Y.;
Qiao, R. H.; Zong, W. H.; Zhang, Y.; Lou, W.; Chen, Z. Y.; Zhu, Y.;
Peng, D. R.; Ding, S. X.; Xu, X. F.; Hou, X. H.; Jia, W. P., Prevalence
of unruptured cerebral aneurysms in Chinese adults aged 35 to 75 years:
a cross-sectional study. \emph{Ann Intern Med} \textbf{2013,}
\emph{159}(8), 514-21.

20. Tarp, B.; Fiirgaard, B.; Christensen, T.; Jensen, J. J.; Black, F.
T., The prevalence and significance of incidental paranasal sinus
abnormalities on MRI. \emph{Rhinology} \textbf{2000,} \emph{38} (1),
33-8.

21. Shi, J. B.; Fu, Q. L.; Zhang, H.; Cheng, L.; Wang, Y. J.; Zhu, D.
D.; Lv, W.; Liu, S. X.; Li, P. Z.; Ou, C. Q.; Xu, G., Epidemiology of
chronic rhinosinusitis: results from a cross-sectional survey in seven
Chinese cities. \emph{Allergy} \textbf{2015,} \emph{70} (5), 533-9.

22. Kim, J. H.; Cho, C.; Lee, E. J.; Suh, Y. S.; Choi, B. I.; Kim, K.
S., Prevalence and risk factors of chronic rhinosinusitis in South Korea
according to diagnostic criteria. \emph{Rhinology}
\textbf{2016,}\emph{54} (4), 329-335.

23. Sugiura, S.; Yasue, M.; Uchida, Y.; Teranishi, M.; Sone, M.; Suzuki,
H.; Nakashima, T.; Otsuka, R.; Ando, F.; Shimokata, H., Prevalence and
Risk Factors of MRI Abnormality Which Was Suspected as Sinusitis in
Japanese Middle-Aged and Elderly Community Dwellers. \emph{Biomed Res
Int} \textbf{2018,} \emph{2018} , 4096845.

24. Hirsch, A. G.; Stewart, W. F.; Sundaresan, A. S.; Young, A. J.;
Kennedy, T. L.; Scott Greene, J.; Feng, W.; Tan, B. K.; Schleimer, R.
P.; Kern, R. C.; Lidder, A.; Schwartz, B. S., Nasal and sinus symptoms
and chronic rhinosinusitis in a population-based sample.
\emph{Allergy}\textbf{2017,} \emph{72} (2), 274-281.

25. Soler, Z. M.; Mace, J. C.; Litvack, J. R.; Smith, T. L., Chronic
rhinosinusitis, race, and ethnicity. \emph{Am J Rhinol
Allergy}\textbf{2012,} \emph{26} (2), 110-6.

26. del Rio, A.; Trost, N.; Tartaglia, C.; O'Leary, S. J.; Michael, P.,
Seasonality and incidental sinus abnormality reporting on MRI in an
Australian climate. \emph{Rhinology} \textbf{2012,} \emph{50} (3),
319-24.

27. Kim, Y. S.; Kim, N. H.; Seong, S. Y.; Kim, K. R.; Lee, G. B.; Kim,
K. S., Prevalence and risk factors of chronic rhinosinusitis in
Korea.\emph{Am J Rhinol Allergy} \textbf{2011,} \emph{25} (3), 117-21.

28. Chen, Y.; Dales, R.; Lin, M., The epidemiology of chronic
rhinosinusitis in Canadians. \emph{Laryngoscope}
\textbf{2003,}\emph{113} (7), 1199-205.

29. Baptist, A. P.; Nyenhuis, S., Rhinitis in the Elderly. \emph{Immunol
Allergy Clin North Am} \textbf{2016,} \emph{36} (2), 343-57.

30. Hisinger-Molkanen, H.; Piirila, P.; Haahtela, T.; Sovijarvi, A.;
Pallasaho, P., Smoking, environmental tobacco smoke and occupational
irritants increase the risk of chronic rhinitis. \emph{World Allergy
Organ J} \textbf{2018,} \emph{11} (1), 6.

31. Kjaergaard, T.; Cvancarova, M.; Steinsvaag, S. K., Smoker's nose:
structural and functional characteristics.
\emph{Laryngoscope}\textbf{2010,} \emph{120} (7), 1475-80.

32. Tint, D.; Kubala, S.; Toskala, E., Risk Factors and Comorbidities in
Chronic Rhinosinusitis. \emph{Curr Allergy Asthma Rep}
\textbf{2016,}\emph{16} (2), 16.

33. Gilani, S.; Shin, J. J., The Burden and Visit Prevalence of
Pediatric Chronic Rhinosinusitis. \emph{Otolaryngol Head Neck
Surg}\textbf{2017,} \emph{157} (6), 1048-1052.

\textbf{Tables}

\textbf{Table 1. Characteristics of the study participants}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Characteristic\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Total (n=4813)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Paranasal sinusitis\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Paranasal sinusitis\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
p-value\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Yes (n=740)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
No (n=4073)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Mean age, years (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
53.1 (10.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
54.1 (10)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
52.9 (10.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.002\textsuperscript{\textbf{*}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Male/Female, n/n\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2368/2445\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
475/265\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1893/2180\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{\textbf{*}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Mean body mass index, kg/m\textsuperscript{2} (SD)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
23.6 (3.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
23.9 (3.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
23.6 (3.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.011\textsuperscript{\textbf{*}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Smoking, n (\%)\textsuperscript{+}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1056 (21.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
238 (32.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
818 (20.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{\textbf{*}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Alcohol consumption, n (\%)\textsuperscript{++}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
614 (12.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
12 (17.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
488 (12.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{\textbf{*}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Hypertension, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1205 (25.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
212 (28.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
993 (24.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.014\textsuperscript{\textbf{*}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Diabetes, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
346 (7.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
59 (8.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
287 (7.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.369\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Hyperlipidemia, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
378 (7.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
67 (9.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
311 (7.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.187\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Stroke, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
141 (3.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
31 (4.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
31 (4.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.027\textsuperscript{\textbf{*}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Coronary heart disease, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
103 (2.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
21 (2.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
82 (2.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.154\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Myocardial infarction, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
17 (0.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5 (0.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
12 (0.3)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.108\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Arrhythmia, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
90 (1.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
18 (2.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
72 (1.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.219\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}\selectlanguage{english}
\begin{longtable}[]{@{}l@{}}
\toprule
*p\textless{}0.05, comparison between participants with and without
paranasal sinusitis +Smoked \textgreater{}100 cigarettes in a lifetime
++Consumption of \textgreater{}30 g of alcohol per week for longer than 1
year SD = standard deviation\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 2: Logistic regression analysis of risk factors associated
with paranasal sinusitis}\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
Risk factor & Crude & Crude & Model A & Model A & Model B & Model
B\tabularnewline
\midrule
\endhead
& OR (95 \% CI) & p-value & OR (95 \% CI) & p-value & OR (95 \% CI) &
p-value\tabularnewline
Age (increase of 10 years) & 1.11 (1.03--1.20) & 0.007 & 1.12
(1.04--1.21) & 0.005\textsuperscript{+} & 1.09 (1.01--1.18) &
0.036\tabularnewline
Male & 2.06 (1.76--2.43) & \textless{}0.001 & 2.07 (1.76--2.44) &
\textless{}0.001\textsuperscript{++} & 1.86 (1.54--2.24) &
\textless{}0.001\tabularnewline
BMI (increase of 1 unit) & 1.23 (1.05--1.44) & 0.011 & 1.20 (1.03--1.41)
& 0.022 & 1.13 (0.93--1.36) & 0.214\tabularnewline
Smoking & 1.89 (1.59--2.24) & \textless{}0.001 & 1.35 (1.11--1.65) &
0.003 & 1.37 (1.10--1.70) & 0.004\tabularnewline
Alcohol consumption & 1.51 (1.22--1.87) & \textless{}0.001 & 1.09
(0.87--1.36) & 0.461 & 0.90 (0.70--1.16) & 0.414\tabularnewline
Hypertension & 1.25 (1.05--1.48) & 0.014 & 1.19 (0.99--1.43) & 0.060 &
1.13 (0.93--1.36) & 0.214\tabularnewline
Stroke & 1.58 (1.05--2.37) & 0.028 & 1.56 (1.03--2.36) & 0.037 & 1.40
(0.92--2.14) & 0.117\tabularnewline
\bottomrule
\end{longtable}

Model A: adjusted for age and sex. Model B: adjusted for all factors

+Adjusted for sex; ++Adjusted for age

OR = odds ratio, CI = confidence interval, BMI = body mass index

\textbf{Table 3. Age-specific prevalence of paranasal sinusitis in
smokers and non-smokers}\selectlanguage{english}
\begin{longtable}[]{@{}llllllllll@{}}
\toprule
\begin{minipage}[b]{0.07\columnwidth}\raggedright\strut
Age (years)\strut
\end{minipage} & \begin{minipage}[b]{0.07\columnwidth}\raggedright\strut
Total\strut
\end{minipage} & \begin{minipage}[b]{0.07\columnwidth}\raggedright\strut
Total\strut
\end{minipage} & \begin{minipage}[b]{0.07\columnwidth}\raggedright\strut
Total\strut
\end{minipage} & \begin{minipage}[b]{0.07\columnwidth}\raggedright\strut
Non-smokers\strut
\end{minipage} & \begin{minipage}[b]{0.07\columnwidth}\raggedright\strut
Non-smokers\strut
\end{minipage} & \begin{minipage}[b]{0.07\columnwidth}\raggedright\strut
Non-smokers\strut
\end{minipage} & \begin{minipage}[b]{0.07\columnwidth}\raggedright\strut
Smokers\strut
\end{minipage} & \begin{minipage}[b]{0.07\columnwidth}\raggedright\strut
Smokers\strut
\end{minipage} & \begin{minipage}[b]{0.07\columnwidth}\raggedright\strut
Smokers\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Investigated, n\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Paranasal sinusitis\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Paranasal sinusitis\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Investigated, n\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Paranasal sinusitis\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Paranasal sinusitis\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Investigated, n\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Paranasal sinusitis\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Paranasal sinusitis\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Participants, n\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Proportion (95 \% CI)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Participants, n\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Proportion (95 \% CI)\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Participants, n\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Proportion (95 \% CI)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Total\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
4813\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
740\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
15.4 (14.4--16.4)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
3757\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
502\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
13.4 (12.3--14.5)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1056\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
238\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
22.5 (20.0--25.1)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
35--44\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1214\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
153\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
12.6 (10.7--14.5)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1021\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
112\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
11.0 (9.1--12.9)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
193\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
41\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
21.2 (15.5--27.0)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
45--54\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1797\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
287\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
16.0 (14.3--17.7)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1323\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
182\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
13.8 (11.9--15.6)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
474\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
105\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
22.2 (18.4--25.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
55--64\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1066\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
176\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
16.5 (14.3--18.7)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
812\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
116\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
14.3 (11.9--16.7)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
254\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
60\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
23.6 (18.4--28.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
65--75\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
736\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
124\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
16.5 (14.1--19.6)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
601\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
92\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
15.3 (12.4--18.2)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
135\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
32\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
23.7 (16.5--30.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
p-value of trend\textsuperscript{+}\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
0.007\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\textless{}0.001\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
0.499\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

+Calculated using the Cochran--Armitage trend test

CI = confidence interval

\textbf{Table 4. Prevalence of sinusitis in different locations
according to smoking status}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
& Total (n=4813) & Smoking & Smoking & p-value\tabularnewline
\midrule
\endhead
& & Yes (n=1056) & No (n=3757) &\tabularnewline
Maxillary sinusitis, n (\%) & 643 (13.4) & 202 (19.1) & 441 (11.7) &
\textless{}0.001\textsuperscript{\textbf{*}}\tabularnewline
Ethmoid sinusitis, n (\%) & 69 (1.4) & 31 (2.9) & 38 (1.0) &
\textless{}0.001\textsuperscript{\textbf{*}}\tabularnewline
Frontal sinusitis, n (\%) & 70 (1.5) & 23 (2.2) & 47 (1.3) &
0.026\textsuperscript{\textbf{*}}\tabularnewline
Sphenoiditis, n (\%) & 78 (1.6) & 19 (1.8) & 59 (1.6) &
0.603\tabularnewline
\bottomrule
\end{longtable}

*p\textless{}0.05, comparison between smokers and non-smokers

\textbf{Figure 1} .\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\textbf{Figure Legends}

\textbf{Figure 1} . Age-specific prevalence of paranasal sinusitis in
smokers and non-smokers. (P = p-value of the Cochran--Armitage trend
test)

\selectlanguage{english}
\FloatBarrier
\end{document}

