Potential Link Between Sinonasal Inflammation and Cognitive Function Warrants Future Study

by Linda Kossoff •

What is the association of sinonasal inflammation with functional brain connectivity (Fc), which may underlie chronic rhinosinusitis (CRS)-related cognitive changes?

BOTTOM LINE

Study participants with sinonasal inflammation show decreased brain connectivity within a major functional hub with a central role in modulation cognition, and future studies are warranted to determine possible immunological associations of sinonasal inflammation and cognition.

BACKGROUND: In recent years, there have been several meaningful advances in the understanding of the cognitive effects of CRS; however, an investigation exploring the potential link between the underlying inflammatory disease and higher order neural processing has not yet been performed.

COMMENT: In this case–control study of 22 patients with chronic rhinosinusitis and 22 healthy controls, the authors compared functional MRI imaging in a proof-of-concept study and identified alterations in brain activity. These changes offer potential neural correlates of the cognitive dysfunction, which has been seen in patients with sinonasal inflammation. Notable alterations in connectivity were found within the neural networks that modulate cognition, introspection, and response to external stimuli. —Subinoy Das, MD

STUDY DESIGN: Case-control study.

SETTING: Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle.

SYNOPSIS: Seeking potential neural correlates for the cognitive dysfunction seen in CRS, researchers drew upon an open-access demographic, imaging, and behavioral data set of adults aged 22 to 35 and identified 22 participants who demonstrated sinonasal inflammation. They used resting-state functional magnetic resonance imaging data to examine the Fc profile of brain networks involved in cognitive processing in these patients compared with a control group of age-matched and sex-matched healthy controls. Results showed similar overall cognitive and sensory status between groups, but an independent component analysis showed decreased Fc in participants with sinonasal inflammation within a region of the frontoparietal network, which has a central role in modulating cognition. The magnitude of this finding increased with inflammation level increases. This region demonstrated increased Fc to areas within the default–mode network, activated in introspective and self-referential processing, and decreased connectivity to nodes within the salience network, which involves detection and response to relevant stimuli. Study limitations included its basis on young, cognitively normal participants, and a retrospective design that did not involve follow-up assessments.

CITATION: Jafari A, de Lima Xavier L, Bernstein JD, et al. Association of sinonasal inflammation with functional brain connectivity [published online ahead of print April 8, 2021]. JAMA Otolaryngol Head Neck Surg.