Carol Yan, MD, an otolaryngologist–head and neck surgeon and assistant professor of surgery at the University of California, San Diego, sometimes has patients whose chronic rhinosinusitis (CRS) has flared after returning from trips to hotter environments and higher pollen counts.
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August 2022
Carol Yan, MD
“Their symptoms are often immediately worse, or they suffer from a prolonged exacerbation even upon returning to San Diego,” she said. “This can be seen in both medically managed and post-surgical patients with CRS.” The inflammation in the sinus leads to more thick discharge, a greater polyp burden, and even systemic therapy, she said.
We will likely see even greater clinical collaboration amongst otolaryngologists, allergist-immunologists, and pulmonologists.
—Carol Yan, MD
Although she can’t definitively connect the dots between climate change and the disease, “I think that is very much a possibility,” she said.
Whether, and to what extent, otolaryngologic diseases can be connected to climate change is still unclear, but it’s certainly a topic generating more interest in the field. Researchers are putting real numbers to the effects that human-induced environmental changes are having on the amount of pollution in the air from wildfires, on the length of our pollen seasons, and on pollen counts. They’re also establishing that there are associations between those changes and health, including conditions such as CRS.
The Climate Connection
The potential effects of these climate-related conditions pose challenges for otolaryngologists, who are treating increasingly stubborn disease. But researchers hope that clarifying the problems can also help guide the way to better management.
“In the last five years, our understanding of the link between climate change—and its downstream effects—and CRS have really grown,” said Murray Ramanathan, MD, professor of otolaryngology–head and neck surgery at Johns Hopkins University in Baltimore.
In what is thought to be the first time, researchers have shown that environmental conditions are linked to developing CRS. Dr. Ramanathan and his colleagues last year compared 2,000 people with CRS to 4,000 people without CRS. To gauge their exposure to fine particulate matter—PM 2.5, or particulate matter with a diameter of 2.5 microns or smaller—researchers used environmental data and residential zip codes. (PM 2.5 includes airborne particles such as car exhaust and smoke.)
The researchers looked back at PM 2.5 exposure rates one year, two years, three years, and five years before the date when subjects were diagnosed with CRS. (The CRS was validated with CT scans, and the control subjects were verified not to have CRS on CT scan as well.) Exposure at all time points correlated with CRS, averaging out to about 1.3 times the risk. Exposure was associated even more strongly with severe CRS, at about three times the risk after adjusting for smoking status (Am J Respir Crit Care Med. 2021;204:859-862). The association was most pronounced for the ethmoid sinus. Although a cause couldn’t be ascertained from the findings, the study offers a definitive association between the two, Dr. Ramanathan said. One weakness of this study, however, was that almost all of the patients were from the Northeastern U.S.