Erica Lamberg
Sinus headaches and pressure, nasal irritation and related symptoms, as well as sinusitis are common issues affecting patients in primary-care practices. These symptoms may be attributable to weather changes, the common cold or flu, or — surprisingly — may manifest as potential side effects of GLP-1 medications.
Sinusitis is not commonly cited as side effect of GLP-1s; however, some research has shown that symptoms such as nasal congestion, postnasal drip, and sinus discomfort could be tied to GLP-1 use.
Although these symptoms have not been definitively established as direct side effects of GLP medications, they could cause sinus complications and warrant clinical attention. Primary care physicians (PCPs) may want to proactively discuss atypical sinusitis symptoms for care management.
Sinusitis in Primary Care
Sinusitis is generally defined as inflammation of the lining of the sinuses. The most common form of sinusitis is acute sinusitis, and the most common etiology is viral, said Christie Barnes, MD, associate professor in the University of Nebraska Medical Center’s Department of Otolaryngology-Head and Neck Surgery in Omaha, Nebraska.
Christie Barnes, MD“Symptoms of acute sinusitis include, rhinorrhea, nasal obstruction, facial pain and pressure and decreased sense of smell,” she said. “Viral and bacterial sinusitis are commonly confused due to the overlap of symptoms. We tend to think that time course is the most predictable differentiator between the two.”
Symptoms lasting more than 10-14 days or are worsening instead of getting better at the end of this time frame is more consistent with a bacterial infection, Barnes said.
The Clinical Intersection
Clinical evidence indicates that GLP-1s may be associated with sinus and ear conditions, such as sinusitis, nasal congestion, and increased facial pressure due to inflammation of the nasal passages and stimulation of the vagus nerve.
Moreover, research has suggested an association between gastroesophageal reflux disease and sinusitis, said Sarah Hermans, MD, a board-certified internal medicine physician at The Ohio State University Wexner Medical Center in Columbus, Ohio.
Sarah Hermans, MD“The relationship is unclear but may be related to a nasal-esophageal reflex. Some studies have demonstrated improvement in post-nasal discharge with proton pump inhibitor use,” she said.
Specific patient populations are predisposed to getting sinusitis or having recurrent or chronic sinus issues, said Hermans. These include patients with ventilation disorders of the sinuses (nasal turbinate hypertrophy, nasal polyps, deviated septum), cystic fibrosis, bronchiectasis, ciliary dyskinesia, acetylsalicylic acid/nonsteroidal anti-inflammatory drugs exacerbated respiratory disease, immunodeficiency, or asthma, reported Hermans.
Furthermore, PCPs should recognize how supportive measures can be very helpful for this time frame.
“Sinus rinses are incredibly helpful on the onset of viral URI and can help stave off bacterial infections,” said Barnes.
In addition, brief (3 days or fewer) of topical nasal decongestants such as oxymetazoline can help alleviate symptoms as well as anti-inflammatory medications to help with facial pressure, Barnes stated.
Symptom Management for Chronic Sinusitis
For symptomatic management of acute cases of either viral or bacterial sinusitis, the use of analgesics, intranasal corticosteroids, and saline nasal irrigation is advised. Caution patients that decongestants may be used for temporary relief but not longer than 3 days.
“Watchful waiting is recommended, but patients should seek care if symptoms fail to improve or improve and then worsen after 10 days,” said Hermans. To prevent rhinosinusitis, advise patients to maintain hand hygiene, stay up to date on vaccines, and avoid tobacco and alcohol, she said. Concerning symptoms to be alert for include persistent or high fevers of over 102 °F lasting more than 3 days, significant facial swelling, increase in facial pain, change in mental status, vision changes, issues with eye movement, and changes in mental status, Hermans said.
Debate: Do GLP-1s Improve Sinus Health?
Barnes told Medscape that the direct evidence specifically examining GLP-1s’ impact as an actor of chronic sinusitis is sparse. However, she added that there has been a recent retrospective cohort study that found that GLP-1 use in patients with chronic rhinosinusitis with nasal polyps who underwent endoscopic sinus surgery was associated with a significantly reduced revision surgery rate at both 1 year (risk ratio [RR], 0.64) and 5 years (RR, 0.60) follow up, as well as a reduced need for first-time biologic prescriptions at 5 years (RR, 0.72).
“Although not fully understood the proposed mechanism is that the benefits include both a direct anti-inflammatory effects and indirect effects through weight loss and metabolic improvement,” she said. “Obesity is considered a pro-inflammatory state; co-morbidities such as DM and foods that tend to result in these conditions are also linked to inflammation and the thought is that these medications reduce both these states to improve overall inflammation.”
Moreover, she said a review of the current literature reveals a recent meta-analysis of 136 randomized controlled trials demonstrating that GLP-1 treatment was associated with reduced serious respiratory infections (RR, 0.84) with great weight loss and A1c reduction correlating with lower infection risk.
“Anecdotally, weight rection and a healthy diet free of ultra-processed foods does appear to play a role in a patient’s sinonasal health and I regularly recommend this to patients with obesity related complications and concomitant sinus disease,” Barnes said.
No disclosures were reported.
