Biological sex as a modulator in rhinologic anatomy, physiology, and pathology: A scoping review

Shreya P. Ramkumar, Tripti Brar, Lisa Marks, Michael J. Marino, Devyani Lal

Research output: Contribution to journalReview articlepeer-review


Background: Biological sex is increasingly recognized as a critical variable in health care. The authors reviewed the current literature regarding sex-based differences in rhinology to summarize the data and identify critical knowledge gaps. Methods: A scoping review was conducted. Publications reporting sex-based differences in anatomy, physiology, and pathology focusing on disease prevalence, disease burden, and outcomes in rhinology were identified. Results: Seventy-five relevant manuscripts were identified. While paranasal sinuses are of similar size at birth, they become larger in males leading to differences in ostium location. Females outperform males in olfactory identification but only in the 18- to 50-year age group. Estrogen and progesterone administration can impact muscarinic and α1-adrenergic nasal mucosa receptor density. Chronic rhinosinusitis (CRS) and CRS without nasal polyps are more prevalent in females while CRS with nasal polyps is more prevalent in males. CRS symptom burden is higher in females before and after endoscopic sinus surgery; however, no difference in endoscopic sinus surgery utilization was found based on sex. Allergic rhinitis is more common in males before puberty and in females after puberty. Epistaxis is more prevalent in males and postmenopausal females compared with premenopausal females, perhaps from differences in sex-hormonal and hypertension status. In nasopharyngeal carcinoma, the incidence of sinus abnormalities was higher in males than females. Conclusions: Although many sex-based differences exist in rhinology, further research is necessary to offer evidence-based treatment guidelines. Gonadal hormones should be studied as a therapeutic in rhinologic pathology as baseline physiologic differences exist such as those found in nasal mucosa receptor density.

Original languageEnglish (US)
Pages (from-to)1783-1800
Number of pages18
JournalInternational Forum of Allergy and Rhinology
Issue number9
StatePublished - Sep 2023


  • chronic rhinosinusitis
  • epistaxis
  • gender
  • olfaction
  • quality of life
  • sex-related
  • sinus anatomy
  • sinusitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology


Dive into the research topics of 'Biological sex as a modulator in rhinologic anatomy, physiology, and pathology: A scoping review'. Together they form a unique fingerprint.

Cite this