Chronic rhinosinusitis (CRS) impacts approximately 5% of Canadians. CRS patients suffer from a combination of symptoms that include facial pain, nasal obstruction, hyposmia and mucopurulence discharge. Asthma may additionally worsen quality of life and many patients suffer from both conditions. The unified airway model illustrates a link between both conditions as tissue from the middle ear to the sinus cavity to the lungs function as one unit. Despite evidence for the unified airway model in the setting of CRS and asthma, there are no studies to our knowledge that have evaluated the microbiome (the resident microbes and their genetic expressions that affect disease) of the upper and lower airways in this patient population. Determining the microbiome of the upper and lower airways in patients suffering from CRS and asthma will further support the unified airway model but more importantly, will help contribute to understanding the pathophysiology of this inflammatory process and may help guide future management.

Inclusion Criteria:

• 19 years or older
• Able to speak and understand English
• Diagnosed with chronic rhinosinusitis with or without asthma and COPD or with a sinonasal tumor
• Undergoing sinus surgery in St Paul's Hospital

Exclusion Criteria:

• Oral antibiotics in the past month prior to surgery;
• Immunocompromised;
• Prior lung transplants;
• Known sinonasal or bronchial tumors, current or previous;
• Smoking;
• Known bleeding disorders:
• Deemed unfit by the rhinologists/respirologist for bronchoscopy.

We will analyze and compare the upper and lower airways from 12 CRS with asthma patients and 12 CRS without asthma patients matched for age, sex and degree of sinus disease based on CT grading using Lund-Mackay staging system.14