CRS and Mental Health: The Burden of Chronic Inflammation on Quality of Life
- Dhanvin Raj Puppala
- Mar 29
- 3 min read
Updated: Apr 1
Hinosinusitis (CRS) is a long-lasting inflammatory condition of the sinuses, persisting for 12 weeks or more, that significantly impacts a patient’s quality of life. It is characterized by persistent nasal congestion, facial pressure, and sinus pain, resulting from the sinuses' inability to effectively drain mucus. Although its physical symptoms are well documented the mental well-being of the patients is often overlocked. Studies have shown that individuals with CRS experience higher rates of depression, anxiety, and cognitive impairment, largely due to chronic inflammation and its systemic effects.
Inflammation links
Studies show there is a strong correlation between inflammation caused by CRS and mental health. This is highlighted by pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α. These inflammatory molecules can cross the blood-brain barrier, altering neurotransmitter function and contributing to mood disturbances. The cytokine hypothesis of depression suggests that chronic inflammation plays a direct role in the development of depressive symptoms by disrupting serotonin and dopamine regulation. Moreover, it is hypothesized, the physical and emotional stress (i.e. hospital visits or surgical procedures), can cause dysregulation Hypothalamic-Pituitary-Adrenal Axis (HPA) in patients which may lead to increased stress hormone production, further exacerbating anxiety and depressive symptoms.
Sleep disturbances and its correlation to poor mental health
Due to airway obstruction CRS patients suffer from poor sleep quality, insomnia, and even obstructive sleep apnea due to nasal obstruction. As highlighted by the studies dysfunctional sleep is well known to decreased quality of life and is linked to poor functional and increase the risk of mood disorders and cognitive dysfunction, affecting attention, memory, and emotional regulation. This can interfere with work, social interactions, and overall quality of life.
Holistic approach to management
The mental wellbeing is not well understood, and more research is required to enhance patient centred care. Physician should routinely take into consideration both physical symptoms and access the mental symptoms to improve patient’s quality of life. For example, using tools like the Sino-Nasal Outcome Test (SNOT-22) to assess both physical and emotional well-being. To combat the inflammation treatment strategies should also focus on reducing systemic inflammation, not just nasal symptoms. Emerging biologic therapies, such as dupilumab (IL-4/IL-13 inhibitors), show promise in reducing inflammation and potentially improving mental health outcomes. Additionally, lifestyle modifications, including exercise, stress management techniques, and dietary changes, may help mitigate both sinus-related and psychological symptoms.
Conclusion
CRS as a condition that extends beyond the sinuses and it is crucial to provide comprehensive patient care. Addressing the mental health burden associated with CRS requires a multidisciplinary approach, combining medical therapy, psychological interventions, and lifestyle changes. By integrating mental health screening and anti-inflammatory treatments into CRS management, clinicians can improve both the physical and emotional well-being of patients suffering from this chronic condition.
Citations
Fan H, Han Z, Gong X, Wu Y, Fu Y, Zhu T, Li H. Prevalence and predictors of depression and anxiety in patients with chronic rhinosinusitis: a systematic review and meta-analysis. BMJ Open. 2024 Mar 15;14(3):e079273. doi: 10.1136/bmjopen-2023-079273. PMID: 38490652; PMCID: PMC10946353.
Kariyawasam HH. Chronic rhinosinusitis with nasal polyps: mechanistic insights from targeting IL-4 and IL-13 via IL-4Rα inhibition with dupilumab. Expert Rev Clin Immunol. 2020 Dec;16(12):1115-1125. doi: 10.1080/1744666X.2021.1847083. Epub 2020 Nov 15. PMID: 33148074.
Mahdavinia M, Schleimer RP, Keshavarzian A. Sleep disruption in chronic rhinosinusitis. Expert Rev Anti Infect Ther. 2017 May;15(5):457-465. doi: 10.1080/14787210.2017.1294063. Epub 2017 Feb 17. PMID: 28276943; PMCID: PMC5967413.
Min, Y. G., & Lee, K. S. (2000). The role of cytokines in rhinosinusitis. Journal of Korean Medical Science, 15(3), 255. https://doi.org/10.3346/jkms.2000.15.3.255
Professional, C. C. M. (2024, May 1). Hypothalamic-Pituitary-Adrenal (HPA) axis. Cleveland Clinic. https://my.clevelandclinic.org/health/body/hypothalamic-pituitary-adrenal-hpa-axis
Owens JA, Weiss MR. Insufficient sleep in adolescents: causes and consequences. Minerva Pediatr. 2017 Aug;69(4):326-336. doi: 10.23736/S0026-4946.17.04914-3. Epub 2017 Feb 17. PMID: 28211649.
Papagiannopoulos P, Kuan EC, Tajudeen BA. Chronic rhinosinusitis and sleep quality. Curr Opin Otolaryngol Head Neck Surg. 2020 Feb;28(1):11-13. doi: 10.1097/MOO.0000000000000600. PMID: 31789930.
Picture:Unknown Artist. (2018, April 20). [Image from "The Difference Between Mental Health and Mental Illness" article]. Digital Image. In Psychology Today. Retrieved from https://www.psychologytoday.com/ie/blog/reaching-across-the-divide/201804/the-difference-between-mental-health-and-mental-illness
Assessed and Endorsed by the MedReport Medical Review Board