Abstract
Objective
Silent sinus syndrome (SSS) usually manifests clinically as hypoglobus and enophthalmos.
Patients may experience different symptoms and may present to an assortment of specialties
and delay diagnosis and management. The objective of this article was to describe
the different and sometimes misleading signs and symptoms of SSS to improve the level
of suspicion and reduce time to diagnosis.
Methods
A retrospective consecutive audit of the records of all patients diagnosed with SSS
between 2015 and 2019 in the Oxford Eye Hospital, Oxford University Hospitals NHS
Foundation Trust. Demographic and clinical data including presentation, diagnosis,
and symptoms were obtained from the patients’ medical files.
Results
Ten patients were included; mean age was 42.5 ± 11.5 years (range, 16–56 years). Four
patients were initially referred to an ophthalmologist with globe asymmetry, diplopia,
eyelid asymmetry, or retraction. Three patients were initially referred to an ear,
nose, and throat specialist with facial asymmetry or infraorbital paraesthesia. Two
patients were referred from the maxillofacial department with an incidental finding,
and the last patient was seen initially by the neurology team with headaches.
Conclusion
SSS has a variable presentation. Patients may have common or misleading signs. Patients
may attend different clinics and subspecialties, and physicians should be aware of
the broad range of presenting signs in this condition to prevent delay in diagnosis
and further morbidity.
Résumé
Objectif
Du point de vue clinique, le syndrome du sinus silencieux (SSS) prend habituellement
la forme d'un hypoglobe et d'une énophtalmie. Cela dit, les patients peuvent présenter
tout un éventail de symptômes et consulter divers spécialistes, ce qui retarde le
diagnostic et le traitement. Le présent article vise à décrire les différents signes
et symptômes, parfois trompeurs, du SSS pour accroître la vigilance des médecins de
façon à raccourcir le délai avant l’établissement du diagnostic.
Méthodes
Nous avons procédé à une vérification rétrospective des dossiers médicaux de tous
les patients consécutifs qui ont reçu un diagnostic de SSS entre 2015 et 2019 à l'Oxford
Eye Hospital. Les données démographiques et cliniques – résultats de l'examen initial,
diagnostic et symptômes – ont été tirées des dossiers médicaux des patients.
Résultats
Dix patients ont été inclus; leur âge moyen s’élevait à 42,5 ± 11,5 ans (fourchette :
16–56 ans). De ce nombre, 4 patients avaient d'abord été adressés à un ophtalmologiste
en raison d'une asymétrie des globes oculaires, d'une diplopie ou encore d'une asymétrie
ou d'une rétraction des paupières. Trois autres patients avaient d'abord été adressés
à un otorhinolaryngologiste en raison d'une asymétrie du visage ou d'une paresthésie
infra-orbitaire. Deux patients avaient d'abord consulté un spécialiste maxillofacial
pour ensuite nous être adressés en raison d'une découverte fortuite. Enfin, le dernier
patient a d'abord consulté un neurologue pour cause de céphalées.
Conclusion
Le SSS peut prendre plusieurs formes, dont les signes et les symptômes se chevauchent
et peuvent être trompeurs. Voilà qui peut amener les patients à consulter plusieurs
spécialistes dans diverses cliniques. Les médecins doivent donc être au courant de
la variété des signes qui peuvent annoncer le SSS, afin d’éviter les délais en matière
de diagnostic et les risques de morbidité supplémentaire.
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Article info
Publication history
Published online: October 26, 2021
Accepted:
September 27,
2021
Received in revised form:
September 16,
2021
Received:
March 1,
2021
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of Canadian Ophthalmological Society.
