People who suffer from a common chronic sinus disorder may be more likely than those who don't to develop depression and anxiety, a Korean study suggests.
Researchers focused on chronic rhinosinusitis, which happens when the cavities around the nasal passages are inflamed and swollen for at least 12 weeks. Symptoms can include facial pain and headaches, nasal obstruction and an impaired sense of smell.
The condition has long been linked to a lower quality of life and problems with physical, social, emotional and cognitive functioning, researchers note in JAMA Otolaryngology Head & Neck Surgery. Even though depression and anxiety commonly accompany chronic rhinosinusitis, it's unclear whether the mental health issues preceded or followed the sinus issues.
Up to 15 per cent of adults suffer chronic rhinosinusitis at some point in time, previous research suggests.
The current study focused on 16,224 South Korean patients treated for chronic rhinosinusitis from 2002 to 2013 as well as a comparison group of 32,448 similar people who didn't have this issue. None of them had a history of depression or anxiety.
During 11 years of follow-up, patients with chronic sinusitis were over 50 per cent more likely to develop depression or anxiety.
"Despite receiving optimal medical and surgical treatment, some patients with chronic rhinosinusitis have repeated, persistent symptoms, which make this condition challenging to manage," said senior study author Dr. Dong-Kyu Kim of Hallym University College of Medicine in Chuncheon, South Korea.
Patients who also have mental health problems "usually show significantly worse pain and energy levels, as well as difficulty with daily activities, than do patients . . . without mental health problems," Kim said by email.
Everyone with sinusitis in the current study had suffered from the condition for at least 12 weeks when they were diagnosed.
A subset of the participants - 5,461 patients - had nasal polyps, or noncancerous growths in the nasal cavity that can cause difficulty breathing.
Compared to people without sinus issues, those with chronic rhinosinusitis and nasal polyps were 41 per cent more likely to develop depression after the sinus issue was diagnosed and 45 per cent more likely to develop anxiety, the study found.
People with chronic rhinosinusitis without polyps were 61 per cent more likely to become depressed and 63 per cent more likely to develop anxiety than individuals without sinus problems.
The study can't prove whether chronic rhinosinusitis directly causes anxiety or depression. The researchers also lacked information about patients' smoking or alcohol use - which could influence both their sinus condition and mental health issues - as well as data on the severity of sinus and mental health problems, which might affect the connections between the conditions.
It's possible that inflammation in rhinosinusitis leads to the release of certain neurotransmitters - chemicals that affect brain function - that may combine with genetics and other factors to cause psychiatric issues, said Dr. Edward McCoul, director of rhinology and sinus surgery at the Ochsner Clinic in New Orleans, Louisiana.
"At this time, any connection is speculative and much more study is needed," McCoul, who wrote a commentary accompanying the study, said by email.
"We don't want to suggest . . . that if they don't get their sinus infection treated then they're going to go crazy, McCoul added. "But . . . chronic rhinosinusitis is a condition that is often unrecognized by the person who has it - they think they're just having recurring sinus infections - and so, seeking competent care, preferably from an otolaryngologist, could lead to sooner diagnosis and control of the condition."