Face-to-Face

With Johnson Space Center just down the street from the Texas Medical Center and Houston Methodist Hospital, collaboration is both natural and effective. Space medicine has been woven into our department’s history, and this research continues to inspire me and my colleagues. This work also holds personal meaning for me. I was fortunate to be mentored by the late Bobby R. Alford, MD, my former chair who was a pioneering figure in space sciences as past Chair of the National Space Biomedical Research Institute. I also worked alongside my medical school classmate David Hilmers, MD, who pursued his medical career after four Space Shuttle missions in the 1980s and 1990s.

When we think about the health challenges of astronauts, our minds often go to bone density loss, muscle atrophy, or radiation exposure. Yet one of the most common and persistent problems documented aboard the International Space Station (ISS) involves the very region we as otolaryngologists know best: the nose and sinuses. In collaboration with NASA and the unique insights of our colleague Dr. Hilmers, our team recently published the first comprehensive review of sinonasal medical events in long-duration spaceflight. Across more than 70 astronauts, 85 percent experienced sinonasal symptoms — most frequently nasal congestion, sinus pressure, and difficulty equalizing the middle ear. These symptoms were strongly associated with microgravity-induced cranial fluid shifts, confirming what many astronauts describe as the “puffy face” phenomenon during the early weeks of space adaptation. We also found that extravehicular activity (EVA) — spacewalks requiring rapid cabin-to-suit pressure changes — was linked to a higher burden of sinonasal and ear complaints. The physiology is intuitive to us: when air trapped in the sinuses and middle ear expands two- to threefold during depressurization, barotrauma and obstruction are almost inevitable if equalization is incomplete. Of course, fluid dynamics are only part of the story. The ISS is a closed ecosystem with CO₂ concentrations 10–20 times higher than Earth’s atmosphere, contributing to headaches and congestion. Despite high-efficiency particulate filtration, astronauts continue to experience irritation from suspended dust and particulate matter — fibers, food particles, even nail clippings — that remain airborne in microgravity far longer than they would on Earth. For our field, this is more than an interesting footnote in aerospace medicine. As commercial spaceflight expands, passengers with baseline sinonasal disease, allergic rhinitis, or Eustachian tube dysfunction may soon be traveling to orbit. Our specialty will be central to assessing risk, developing pre-flight interventions (e.g., turbinate reduction, optimized allergy control), and guiding medical countermeasures to minimize morbidity during missions. This work reinforces a broader truth: otolaryngology has a unique and growing role in the multidisciplinary care of humans in extreme environments. Just as we manage divers, aviators, and high-altitude explorers, our expertise will help shape the health standards for future astronauts and even space tourists. It is remarkable to think that as we refine treatments for sinonasal obstruction here on Earth, we are simultaneously preparing for their application hundreds of miles above our planet — and one day, perhaps, on the Moon and Mars.