Houston Methodist Researchers Look at Causes, Complications of Chronic Rhinosinusitis

Two groundbreaking new studies by Dr. Omar Ahmed, Dr. Mas Takashima and the Houston Methodist ENT research team aim to unravel the complexities of chronic rhinosinusitis (CRS), shedding light on its origins and broader health implications.

CRS affects nearly 12% of Americans, yet its causes remain elusive. The condition is characterized by prolonged inflammation of the sinus and nasal passages.

The first study, published in the International Forum of Allergy & Rhinology, explores the link between viral infections and CRS. The second, appearing in JAMA Otolaryngology–Head & Neck Surgery, examines the bidirectional relationship between CRS and mental health disorders like anxiety and depression.

The research is part of a broader effort by Houston Methodist to better understand the intricate interplay between infections, inflammation, genetics and mental health.

"Chronic sinusitis is not one disease; it's a constellation of conditions," said Dr. Ahmed, an assistant professor of Otolaryngology at Houston Methodist and primary investigator of both studies. "The better we understand its diverse causes and symptoms, the closer we'll get to developing effective screening and prevention tools and better, more personalized and more effective treatments."

Viral infections as a trigger for chronic rhinosinusitis

The research identifies viral infections such as COVID-19, influenza and RSV as significant precursors to CRS.

Analyzing data from over two million patients, the study found that individuals who had a single viral infection were twice as likely to develop CRS within a year compared to those without.

Recurrent infections raised the risk even further, up to threefold.

"This is really just the first time we've put numbers behind what we ENT specialists have observed for years," said Dr. Takashima, chair of Otolaryngology – Head & Neck Surgery at Houston Methodist and a co-author on both studies. "Viral infections appear to set off an inflammatory cascade or alter the sinus microbiome, potentially leading to chronic inflammation."

The study's findings could have practical implications for early intervention.

"If we can identify high-risk individuals after a viral infection through the AI-based predictive model we're developing, we could intervene early with treatments to prevent chronic rhinosinusitis," Dr. Ahmed explained.

CRS and mental health: A vicious cycle

While the first study focused on viral causes of CRS, a second study examined the connection between CRS and patients' mental health, attempting to parse out if anxiety and depression are causes of chronic inflammation or simply commonly occurring comorbidities due to the discomfort associated with the disease.

Using data from the NIH's All of Us database, the research team found that CRS patients were nearly three times as likely to develop anxiety and 40% more likely to develop depression compared to those without the condition. Conversely, individuals with pre-existing anxiety or depression were significantly more likely to develop CRS.

"The relationship is bidirectional," Dr. Ahmed explained. "CRS can worsen mental health through its impact on quality of life, while mental health issues may weaken the immune system, increasing susceptibility to chronic inflammation to twice the normal amount."

The research also highlighted disparities among certain demographic groups, including individuals with lower socioeconomic status, showing higher vulnerability to both CRS and mental health conditions.

Integrating knowledge to help predict risk

Taken together, the studies emphasize the need for a more comprehensive approach to understanding and treating CRS.

Addressing the bidirectional health challenges could be an important part of CRS management.

"Treating depression or anxiety might not just improve quality of life but also reduce the risk of developing chronic rhinosinusitis or exacerbating its symptoms," explained Dr. Takashima. "Likewise, it could be a major game-changer if we could prevent a minor, temporary viral illness from turning into a lifelong chronic condition with just a little increased vigilance during those first few months."

The research represents just a portion of the work underway at Houston Methodist. The team is pursuing a predictive model incorporating genetic, environmental and clinical data to identify individuals at high risk for CRS. Meanwhile, the researchers will continue to release studies looking at how additional factors like obesity, race and geography affect susceptibility to the disease.