One would expect that subjects exposed to more passive smoke would have a significantly increased level of rhinosinusitis. This study looked at a reasonable number of sinusitis and control subjects (404 and 165) using hair nicotine as an assessment of the amount of exposure to cigarette smoke. Surprisingly, the nicotine levels were similar in the two groups and had not changed over time (one would perhaps expect the sinusitis group to actively avoid smoke after diagnosis). The prevalence of evidence of passive smoke exposure was higher in children, and had not reduced overall in the subjects over time despite many public health measures intended to reduce it. While this does not pretend to be a definitive study, the result is surprising and suggests to me that passive smoking is not a major aetiological factor in the pathophysiology of rhinosinusitis.