Millions of people with chronic sinusitis not only suffer from nasal congestion and headaches, but they also often have difficulty concentrating and experience depression and other brain-related symptoms.
New research links sinus inflammation to changes in brain activity, specifically in neural networks that regulate cognition, introspection and responses to external stimuli.
That piece of paper is Published today in JAMA Otolaryngology-Head and Neck Surgery.
“This is the first study to link chronic sinus inflammation to neurobiological changes,” said lead author Dr. Aria Jafari, assistant professor and surgeon in the Department of Otolaryngology-Head and Neck Surgery at Washington University School of Medicine.
“We know from previous research that patients with sinusitis often decide to seek medical care not because they have runny noses and sinus pressure, but because the disease is affecting the way they interact with the world: They are unable to work productively , confused thinking. Difficulty, poor sleep. It affects their quality of life broadly. Now we have a prospective mechanism for what we observe clinically.”
According to the Centers for Disease Control and Prevention, chronic sinusitis affects approximately 11% of U.S. adults. This condition can require years of treatment, often with antibiotics. Repeated cycles of inflammation and repair cause the sinus tissue to thicken, like calloused skin. Surgery can fix the problem, but symptoms can return.
The researchers identified a study cohort from the Human Connectome Project, an open-access, brain-focused dataset of 1,206 healthy adults aged 22-35 years. Data included radiology image scans and cognitive/behavioral measures.
These scans allowed them to identify 22 people with moderate or severe sinus inflammation, as well as 22 age- and gender-matched controls without sinus inflammation. Functional magnetic resonance (fMRI) scans, which detect cerebral blood flow and neuronal activity, reveal the following distinctive characteristics of study subjects:
- Reduced functional connectivity in the frontoparietal network, a regional hub for executive functioning, maintaining attention, and problem solving;
- Increased functional connectivity to two nodes in the default mode network, which affects self-reference and is active during awake rest and mind-wandering;
- Reduced functional connectivity in salience networks involved in detecting and integrating external stimuli, communication, and social behavior.
The magnitude of the differences in brain activity observed in the study group was similar to the severity of sinus inflammation in the subjects, Jaafari said.
However, despite changes in brain activity, no obvious deficits were found in behavioral and cognitive tests among participants in the study group, said study co-author Dr. Kristina Simonyan. She is an associate professor of otolaryngology-head and neck surgery at Harvard Medical School and director of laryngology research at the Massachusetts Eye and Ear Infirmary.
“The participants with moderate and severe sinus inflammation were young adults who showed no clinically significant signs of cognitive impairment. However, their brain scans told us a different story: People with sinus inflammation Subjective feelings experienced such as decreased attention, difficulty concentrating, or sleep disturbances may be related to subtle changes in how brain regions that control these functions communicate with each other,” Simonian said.
If chronic sinusitis goes untreated, these changes may lead to more clinically significant symptoms, she added. “It is also possible that we have detected early markers of cognitive decline in which sinus inflammation is a precipitating or predictive factor,” Simonyan said.
Jaafari sees the findings as a starting point for exploring new treatments for the disease.
“The next step would be to study people clinically diagnosed with chronic sinusitis. It could involve scanning the patients’ brains, then providing typical treatments for sinus disease with drugs or surgery, and then scanning them again to see if their brain activity changes. Or We can look for inflammatory molecules or markers in the patient’s blood.”
In the bigger picture, he said, the study may help ear, nose and throat specialists focus on the less obvious pain experienced by many chronic sinusitis patients.
“Our care should not be limited to alleviating the most obvious physical symptoms, but should reduce the full burden of a patient’s disease.”
Research funding was provided by the National Institute on Deafness and Other Communication Disorders, part of the National Institutes of Health (NIH) (R01DC011805). Part of the data was provided by the Human Connectome Project, which is funded by 16 NIH institutes and centers (1U54MH091657).