An increase in the prevalence of chronic rhinosinusitis has been shown in children staying in day care centers compared with children staying at home.61 The cleanliness and size of the day care group are important, as large number facilities have a potentially increased viral URI burden predisposing to rhinosi-nusitis.2'48'60 Secondary smoke and inhaled irritant exposure have also been implicated as contributing factors to rhinosi-nusitis, again perhaps by increasing a child's risk of URI.60

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