Chronic sinusitis appears to alter brain activity

Millions of people who have chronic sinusitis not only deal with a stuffy nose and headache, but often struggle to focus and experience depression and other symptoms that imply brain involvement in their disease.

New research links sinusitis to changes in brain activity, especially with neural networks that modulate cognition, introspection, and response to external stimuli.

The paper was published today in JAMA Otolaryngology – Head and Neck Surgery.

“This is the first study to link chronic sinusitis with neurobiological changes,” said lead author Dr. Aria Jafari, surgeon and assistant professor of otolaryngology – head and neck surgery at the University of Washington School of Medicine.

“We know from previous studies that patients who have sinusitis often choose to seek medical help not because they have a runny nose and sinus pressure, but because the disease affects their interaction with the world: . This greatly affects their quality of life. We now have a potential mechanism for what we observe clinically. “

Chronic rhinosinusitis affects about 11% of adults in the United States, according to the Centers for Disease Control and Prevention. The condition may require treatment for several years, usually including antibiotics. Repeated cycles of inflammation and regeneration thicken the sinus tissues, similar to calloused skin. Surgery may solve the problem, but symptoms may recur.

The researchers identified a cohort of studies from the Human Connectome project, an open access, data set focused on the brains of 1,206 healthy adults aged 22-35. Data include radiological imaging and cognitive / behavioral measurements.

The scan allowed them to identify 22 people with moderate or severe sinusitis, as well as a control group of 22 and a half who did not have sinusitis. Functional MRI (fMRI) images, which reveal cerebral blood flow and neural activity, showed these recognizable traits in the subjects:

  • reduced functional connectivity in the frontoparietal network, regional hub for executive functions, maintenance of attention and problem solving;
  • increased functional connection with two nodes in the network with the default mode, which affects self-reference and is active during waking rest and wandering;
  • reduced functional connectivity in a prominent network, which is involved in the detection and integration of external stimuli, communication, and social behavior.

The magnitude of the differences in brain activity observed in the study group is parallel to the severity of sinusitis among the subjects, Jafari said.

Despite the changes in brain activity, however, no significant deficit was observed in the behavioral and cognitive testing of the study group participants, said Dr. Kristina Simonyan, co-author of the study. She is an associate professor of otolaryngology-head and neck surgery at Harvard Medical School and director of laryngological research at Massachusetts Eye and Ear.

“Participants with moderate and severe sinusitis were young individuals who showed no clinically significant signs of cognitive impairment. However, their brain scans told us a different story: subjective feelings of attention decline, difficulty concentrating, or sleep disorders that a person with sinusitis may be associated with subtle changes in the way the brain regions that control these functions communicate with each other, ”he said. Simonyan.

It is likely, she added, that these changes could cause clinically significant symptoms if chronic sinusitis is not treated. “It’s also possible that we were able to detect early markers of cognitive decline, where sinusitis acts as a predisposing trigger or predictive factor,” Simonyan said.

Jafari sees the study’s findings as a launching pad for research into new disease therapies.

“The next step would be to study people who have been clinically diagnosed with chronic sinusitis. This could include scanning the patient’s brain, then providing typical sinus disease treatment with drugs or surgeries, and then re-scanning to determine if their brain activity has changed. Or we could look for inflammatory molecules or markers in the patient’s bloodstream. “

In a broader picture, he said, the study could help ear-nose-throat experts be aware of the less obvious trouble many patients experience with chronic sinusitis.

“Our concern should not be limited to alleviating the most obvious physical symptoms, but to the entire burden of the patient’s illness.”

Funding for the study was provided by the National Institute for Deafness and Other Communication Disorders (R01DC011805), part of the National Institutes of Health (NIH). The data was provided in part by the Human Connectome project, funded by 16 NIH institutes and centers (1U54MH091657).