Chronic rhinosinusitis (CRS) is a commonly reported disorder characterized by persistent inflammation of the mucosa of the nose and paranasal sinuses. Although the pathogenesis remains poorly understood, CRS is thought to be disease arising from the interaction between environmental pathogens and host innate immunity. A number of factors have been implicated as etiologic agents such as bacterial biofilms, superantigens and fungi. However, studies aiming to eradicate these environmental agents have remained inconclusive causing researchers to hypothesize that the pathogenesis of CRS may instead be due to a variety of genetic and epigenetic changes within the host response in select patients. This review will highlight current perspectives on various environmental contributors with an overview of the sinonasal innate immune system and its role in the pathogenesis of CRS.