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. 2025 Aug 5;10(4):e70229.
doi: 10.1002/lio2.70229. eCollection 2025 Aug.

Congestion and Sinonasal Illness in Outer Space: A Study on the International Space Station

Faizaan Khan  1 , Koyal Ansingkar  1 , Roshan Dongre  1 , Zain Mehdi  2 , Aatin K Dhanda  2 , Kayla Powell  2 , Tariq Syed  2 , Samuel E Razmi  1 , Isuru Somawardana  1 , Jeffrey T Vrabec  2 , David Hilmers  3 , Omar G Ahmed  2 , Masayoshi Takashima  2
Affiliations

Congestion and Sinonasal Illness in Outer Space: A Study on the International Space Station

Faizaan Khan et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objectives: This study aims to characterize quantitative data pertaining to sinonasal symptoms and their related medication use aboard the International Space Station (ISS). A secondary focus involves correlating these findings with mission parameters such as extravehicular activity (EVA) participation and mission duration.

Methods: This retrospective cohort study was conducted utilizing data requested from the National Aeronautics and Space Administration (NASA) Lifetime Surveillance of Astronaut Health (LSAH) program.

Results: Of 71 de-identified ISS astronauts beginning with Expedition 1 in the year 2000 through 62 in 2019, there were 754 logged medical events; 60 astronauts reported any type of sinonasal medical event (85%), the most common being general nasal congestion in 53 astronauts (75%). Symptoms were attributed to microgravity-induced fluid shifts in 34 astronauts (57%) while 17 (28%) attributed symptoms to ear clearing and barotrauma. Pseudoephedrine was the most used medication, with 95 recorded uses, followed by oxymetazoline spray at 51. Among the 60 astronauts with sinonasal medical events, the 24 with references to extravehicular activity (EVA) participation in their records had on average, 9.19 more records than those without (95% CI: 2.29-17.06).

Conclusion: Sinonasal symptoms are a prevalent medical concern among astronauts aboard the ISS. The findings suggest that early spaceflight-associated fluid shifts contribute significantly to these symptoms, often requiring medication use. A correlation between EVA participation and a higher number of medical events highlights an occupational risk factor.

Level of evidence: 3.

Keywords: astronaut health; microgravity; sinonasal physiology; sinus congestion; spaceflight.

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Conflict of interest statement

Masayoshi Takashima is a consultant for Neurent Medical and Medtronic ENT. Omar G. Ahmed is a consultant for Aerin Medical and Medtronic ENT. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Sinonasal medical event count by flight day grouping. This bar graph illustrates the number of recorded sinonasal medical events among astronauts aboard the International Space Station (ISS) across different flight day groups. The highest number of events occurred during the first week of spaceflight, followed by a decline in subsequent weeks. Events continue to occur throughout long‐duration missions but at lower frequencies.
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