Houston, We Have a Problem

When people think of otolaryngology, spaceflight is usually not part of the picture. Yet I was drawn to the idea of bringing these two interests together.

At the end of my first year of medical school, I started asking a question: Could I study the effects of spaceflight on ENT health? I began reading on my own and quickly noticed a gap. Astronauts have long described congestion and sinonasal pressure during missions, but surprisingly little published data clearly quantified how often these problems occur, when they occur, and how they are treated.

After a long stretch of searching through NASA.gov, I eventually found human health databases that appeared usable for this research. It felt like a breakthrough, but I soon reached an impasse. Access required a credible research team and institutional support, neither of which I had at the time.

The next day, I sent an email to Masayoshi Takashima, MD, chair of the department of otolaryngology–head and neck surgery at Houston Methodist Hospital. I explained why this was a question worth pursuing, especially in Houston, and why I believed we had an opportunity to be among the first to quantify sinonasal problems in spaceflight and identify related medication use on the International Space Station. I had never met him. I expected little, if any, response.

Instead, he replied the next day with interest and invited me to present the idea to his weekly research group led by Omar G. Ahmed, MD. Over the following months, Dr. Ahmed worked with me to build a study plan, complete the application process, and work with NASA epidemiologists to refine our approach. The experience was surreal. I had gone from being a student with an idea to serving as principal investigator on a study using astronaut medical data.

Our study (Laryngoscope Investig Otolaryngol. doi:10.1002/lio2.70229) asked three practical questions: how many astronauts experience sinonasal symptoms, when do these symptoms occur, and what medications are used to treat them. Using nearly two decades of astronaut medical records from 2000 to 2019, we found that 60 of 71 astronauts reported at least one sinonasal medical issue during their missions. Nasal congestion was the most common problem, affecting 75% of astronauts. The numbers were striking and made one thing clear: This is not something that can be waved off.

We also saw a temporal pattern that aligned with existing theories in space medicine. The highest number of sinonasal medical events occurred during the first week of flight, which supports the idea that cephalad fluid shifts in microgravity contribute to congestion and sinonasal pressure. We also found something interesting regarding extravehicular activity (EVA). Astronauts whose records mentioned EVA activity, or spacewalks, experienced more sinonasal medical events than those who did not. The pressure changes involved in transitioning from the station to a spacesuit likely play a role, and this is something that warrants further study.

What made this project meaningful to me was not just the data, but the people who shaped it. Despite his busy schedule, Dr. Ahmed always made time to chat, brainstorm, and review our progress. I have yet to meet an attending physician in any field who takes mentorship as seriously as Dr. Ahmed. Dr. Takashima consistently pushed us to think beyond our numbers and toward what these findings mean for mission performance. He made the point early on that this is not a comfort issue. As he put it in Houston Methodist’s coverage of the study, “If you’re not sleeping well because you can’t breathe, your cognitive function, reaction time, and mission performance can suffer, and those things are absolutely critical in space.” His framing changed how I thought about our work. We were not cataloguing minor inconveniences. We were identifying a real threat to human performance aboard what is arguably mankind’s most expensive laboratory.

The project additionally benefited from the involvement of David Hilmers, MD, a co-author on the paper. Dr. Hilmers is a veteran of four Space Shuttle missions between 1985 and 1992 and a U.S. Astronaut Hall of Fame inductee. After his career at NASA, he went on to become a physician, and he and Dr. Takashima were classmates in medical school. He’s now a professor in internal medicine, pediatrics, and space medicine at the Center for Space Medicine, Baylor College of Medicine in Houston. Having someone on our team who had personally experienced the environment we were studying gave us a perspective that no dataset alone could provide.

I also see this project as part of a longer tradition within our specialty. Bobby R. Alford, MD, who chaired the department of otolaryngology at Baylor College of Medicine, was a pioneer in connecting otolaryngology to aerospace medicine. He helped found the National Space Biomedical Research Institute and received NASA’s Distinguished Public Service Medal. He recognized early on that our specialty and spaceflight are inherently linked. Dr. Alford was also Dr. Takashima’s chairman, a lineage that makes our study feel more like the continuation of something set in motion decades ago.

A project like this does not happen without institutions that are willing to support unconventional ideas. Houston Methodist has built an innovative environment where a study using NASA data can get off the ground. And the EnMed program, the only four-year program that grants both a Doctor of Medicine and a Master of Engineering, at Texas A&M University, where I am a student, trains us at the intersection of medicine and engineering in a way that pushes us to ask questions a traditional curriculum might not. I am grateful to both institutions for making this work possible.

Dr. Takashima said it well: “Astronauts are typically among the fittest individuals on the planet, yet this study shows that even they experience substantial sinonasal complaints in space. Imagine what happens when civilians with preexisting conditions start traveling to space.”

With our return to the moon drawing closer through the Artemis Program and our sights set on the red planet down the line, the people traveling beyond Earth will not always be in perfect health. Our specialty needs to be prepared for that. The work of understanding how spaceflight impacts ENT health is only beginning.   

Dr. Khan is an incoming otolaryngology resident at Houston Methodist Hospital. His interests lie in medical device innovation and drawing on ideas from outside disciplines to advance otolaryngology. He recently graduated from the Texas A&M School of Engineering Medicine (EnMed), a collaborative program between Texas A&M University and Houston Methodist Hospital that trains physician-engineers to develop solutions at the intersection of medicine and technology, earning both his MD and Master of Engineering. Dr. Ahmed is an associate professor, academic rhinologist, skull base surgeon, and director of clinical research in the department of otolaryngology—head and neck surgery at Houston Methodist Hospital. Dr. Takashima is a professor of otolaryngology and chair of the department of otolaryngology at Houston Methodist. As department chair, he leads a group of 39 faculty across seven systemwide institutions throughout the greater Houston area.

Disclosure: Dr. Ahmed is a consultant for Aerin Medical, Neurent Medical, Spirair, and Sanofi.