Clinical and Nasal Mucosal Functional Phenotype of PCR-Positive Epstein-Barr Virus-Associated Acute Rhinosinusitis: A Prospective Comparative Study

Abstract

Acute rhinosinusitis (ARS) is usually viral and self-limited, but marked heterogeneity exists in symptom burden and mucosal recovery. Epstein-Barr virus (EBV) can persist in nasopharyngeal epithelium, yet the clinical significance of EBV DNA detection during ARS remains uncertain. Objective: To compare clinical severity and nasal mucosal function in EBV PCR-positive and EBV-negative ARS. Methods: A prospective comparative study enrolled 120 adults aged 18-65 years between 2024 and 2026. Sixty had EBV-negative ARS and 60 had PCR-positive EBV-associated ARS. Standardized clinical assessment, nasal endoscopy, computed tomography for study phenotyping, saccharin-based mucociliary clearance testing, nasal secretory and absorptive function tests, and nasal secretion pH assessment were performed. Effect estimates were reconstructed from aggregate study data as risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Results: EBV-positive patients more frequently had persistent nasal obstruction (88.3% vs 71.7%; RR 1.23, 95% CI 1.03-1.48), mucopurulent discharge (48.3% vs 23.3%; RR 2.07, 95% CI 1.22-3.51), olfactory dysfunction (68.3% vs 46.7%; RR 1.46, 95% CI 1.06-2.02), and fatigue/sleep disturbance (78.3% vs 51.7%; RR 1.52, 95% CI 1.15-2.00). Mucociliary clearance was prolonged by 6.5 minutes (28.9±4.2 vs 22.4±3.8 min; MD 6.50, 95% CI 5.07-7.93), nasal secretion pH was lower by 0.44 units (5.98±0.27 vs 6.42±0.24), and secretory volume was reduced by 0.40 mL. Within the EBV-positive group, clearance time correlated with obstruction severity (r=0.69, p<0.001), while pH correlated inversely with clearance time (r=-0.68, p<0.001). Conclusion: PCR-positive EBV-associated ARS showed a more severe clinical and mucosal-functional phenotype than EBV-negative ARS. These findings support EBV positivity as a potential marker of a subgroup with delayed mucosal recovery, while not establishing viral causality.