The crosshairs show sinus area with sinus problems
Brain Science:Chronic sinus issues affects about 11% of U.S. adults, according to the Centers for Disease Control and Prevention.The millions of people who have sinus issues deal not only with stuffy noses and headaches, they also commonly struggle to focus, and experience depression and other symptoms that display the brain's involvement in the illness.Sinusitis is an inflammation of tissues in spaces in your forehead, cheeks and nose. Theses are usually filled with air but with sinus issues thse spces fill up with mucus. It causes facial pain, a stuffy or runny nose, sometimes a fever and other symptoms.
A new study shows that people with chronic sinusitis don’t just have to contend with a stuffy nose and headache; sinusitis can also cause trouble with focus and lead to depression and other symptoms that indicate the brain is affected as well. The study was published in JAMA Otolaryngology–Head & Neck Surgery in April 2021.
According to lead study author Dr. Aria Jafari, surgeon and assistant professor of otolaryngology–head and neck surgery at the University of Washington School of Medicine, “This is the first study that links chronic sinus inflammation with a neurobiological change.”
“Patients who have sinusitis often decide to seek medical care not because they have a runny nose and sinus pressure, but because the disease is affecting how they interact with the world: They can’t be productive, thinking is difficult, sleep is lousy. It broadly impacts their quality of life,” The study was of twenty-two participants with moderate or severe sinus inflammation and 22 control participants underwent functional MRI (fMRI) scans to measure cerebral blood flow and neuronal activity. Results showed those with sinusitis symptoms had:
Reduced functional connectivity in the frontoparietal network, affecting executive function, attention and problem-solving.
Reduced functional connectivity in the salience network, affecting communication, social behavior and response to external stimuli.
Increased functional connectivity within the default-mode network, associated with self-reference, mind-wandering and wakeful rest.
The extent of these effects paralleled the severity of sinus symptoms.
Despite brain-activity changes,behavioral and cognitive tests showed no significant deficit for sinus patients. However, brain scans show that subjective symptoms like poor attention and trouble with sleep may be due to subtle changes in how the brain regions that control these functions communicate with one another.“The participants with moderate and severe sinus inflammation were young individuals who did not show clinically significant signs of cognitive impairment. However, their brain scans told us a different story: The subjective feelings of attention decline, difficulties to focus or sleep disturbances that a person with sinus inflammation experiences might be associated with subtle changes in how brain regions controlling these functions communicate with one another,”
Having said the above it is extremely rare that a sinus infection will cause a brain infection.The human body makes a lot of effort to protect the brain from invading pathogens. One of those is something called the blood-brain barrier, which is a semipermeable membrane that allows only select fluids and nutrients to pass through. But, on rare occasion, bacteria can enter as well. Because the sinuses are so close to the brain, on rare occasions an infection there can creep its way through the barrier. The most common of these rare complications is something called subdural empyema, in which pus (a big viscous mass of white blood cells) collects in the space between the outermost membrane of the brain (the dura mater) and the fine middle membrane known as the arachnoid. Once there, the infection can lead to swelling of the brain, seizures, altered mental state, and vomiting.
So, yes, an sinus infection can (rarely) go to your brain, but here’s the thing: It almost never comes out of nowhere, and it always causes symptoms—like an extremely severe headache. If you have an upper respiratory infection that has lasted way longer than it should (more than two weeks) or you have a severe headache or swelling in your face, you should head straight to the ER.
Brain Facts:
Doctors diagnose 11.6% of American adults with sinusitis.
Every year, sinusitis causes approximately 73 million restricted activity days.
Sinusitis socioeconomic impact exceeds $5.8 billion.
47% of cases improve within one week without antibiotics.
In 2000, sinusitis caused over 1.3 million hospital visits.
Nasal saline promotes quicker healing from sinusitis.
Abnormal CT scans appear in 84-100% of patients with severe asthma.
Antibiotics for chronic rhinosinusitis cost more than $150 million annually.
Acute sinusitis impacts as many as 40 in 1000 patients per year, depending on the area and the time of year.
So What:
So why do some of us get sinus issues and some do not? Certain conditions, such as having allergies, asthma or a respiratory infection, can make people more susceptible to getting chronic sinus infections, and it is important that these patients be evaluated to address the cause and not just the sinusitis symptoms.What can start as inflammation in your sinuses from a respiratory infection, allergies or environmental pollutants can spark a sinus infection when the lining of the sinuses becomes inflamed and swollen, causing mucus to become trapped and germs to grow.Treatment for acute and chronic sinus infections include self-care, over-the-counter and prescription medications, and sinus surgery, if necessary, to enlarge the opening to the sinuses or address other anatomical issues.
So what is different here? Prior to recent studies the treatment of sinus issues have been strictly along the lines of the respiratory issues. What recent studies show is that sinus inflammation may act as as trigger or predictive factor for cognitive decline. We know now, that brain activity changes with sinus infection. Some of the changes are temporary and some are permanent. Perhaps future treatments should look at brain activity as well. It might involve scanning patients' brains, then providing treatments for sinus disease with medication or surgery, and then scanning again to see if their brain activity had changed. The point here is also that patient providers should also look at other effects of the disease, and look at the whole burden of the disease.
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