Silent Sinus Syndrome

What is silent sinus syndrome?

Silent sinus syndrome (SSS) is a health condition affecting your maxillary sinuses, which are nasal passages in your cheek area next to your nose. The condition is characterized by a sunken eye (enophthalmos) and/or the downward displacement of your eyeball in your eye socket (hypoglobus). This occurs due to the collapse of your sinus walls and orbital floor. Your orbital floor forms the roof of your maxillary sinus.

The condition can happen when your sinuses get clogged. Secretions build up in your sinuses and are then reabsorbed. Over time, you end up with a vacuum, and your sinuses get smaller and smaller, leaving more room for your eyes to sink.

Silent sinus syndrome doesn’t usually cause any pain (that’s where the silent part comes in), but it may make your face look asymmetrical. It typically only affects one side of your face, but it can affect both. Treatment is required to prevent worsening symptoms and complications, such as peripheral vision loss (tunnel vision).

How common is this condition?

Silent sinus syndrome is rare. The condition was first described in 1964, and since then, about 100 cases have been reported.

What are the symptoms of silent sinus syndrome?

Silent sinus syndrome symptoms usually progress over a period of weeks to months, but sometimes they occur more rapidly. The most common signs are changes to your physical features.

• Enophthalmos: A sunken eye (enophthalmos) is present in almost all cases of the condition. The measurement of enophthalmos ranges from 2 mm (millimeters) to 6 mm.
• Hypoglobus: The downward displacement of your eyeball in your eye socket (hypoglobus) occurs in about half of all cases. The measurement of hypoglobus ranges from 1 mm to 6 mm.
• Eyelid changes: Upper eyelid position changes occurred in up to 88% of cases.
• Diplopia: Double vision (diplopia) occurred in 28% to 65% of cases in two large studies.

Other symptoms may include:

• Eyelid drooping (ptosis): A condition in which your upper eyelid droops, sags or falls over your eye (also called blepharoptosis).
• Squinting: Eyelid drooping may make it appear that you’re squinting.
• Blurred vision: It’s hard to focus and you can’t see clearly.
• Sinusitis: Sinus inflammation (swelling) and infection.
• Runny nose (rhinorrhoea): Mucus being discharged out of your nose.
• Postnasal drip: When excess mucus builds up and drips down the back of your throat.
• Facial pressure or pain: Pain or pressure around your eyes or sinus areas.

What causes silent sinus syndrome?

Researchers have debated the causes of silent sinus syndrome since its discovery. Most believe the condition occurs due to a blockage in your osteomeatal complex. Your osteomeatal complex is a group of structures that aid in mucus drainage and airflow. Blockages in this area may occur for a variety of reasons and can result in a buildup of secretions in your sinuses.

Your sinuses eventually reabsorb these secretions, causing a vacuum effect. This long-term pressure in your sinuses can lead to slowed breathing and negative pressure, which can cause your sinus walls to move inward. This can also pull down your orbital floor, which can thin and remodel your bone structure.

What are the risk factors for silent sinus syndrome?

Silent sinus syndrome can happen to anyone, but having an underlying unusual nasal anatomy is the greatest risk factor for the condition. Specifically, people with a deviated septum may be at a higher risk of the condition.

People in their 30s and 40s are diagnosed with silent sinus syndrome most often. It occurs equally in people assigned male at birth (AMAB) and people assigned female at birth (AFAB).

Also, people who smoke cigarettes have a higher risk of the condition.

What are the complications of silent sinus syndrome?

If left untreated, silent sinus syndrome can continue to affect your sinuses and contribute to worsening symptoms. Your eye(s) will sink in deeper and your eyeball(s) will become further displaced. This can lead to peripheral vision loss among other health conditions.

How is silent sinus syndrome diagnosed?

Your healthcare provider will perform a physical exam and ask you about your symptoms. They may refer you to an ear, nose and throat (ENT) doctor (otolaryngologist). Your ENT will perform a complete eye exam and will diagnose the condition based on your symptoms. They’ll look for signs such as sunken eyes, displaced eyeballs or droopy eyelids.

Your provider may also request a CT (computed tomography) scan to confirm the condition.

Can silent sinus syndrome be cured?

Yes, most often, silent sinus syndrome treatment includes surgery. Silent sinus syndrome surgery may include:

• Antrostomy: This procedure uses a surgical tool called an endoscope to clear the blockage and normalize sinus drainage. It also enlarges the area of your sinuses causing the issue.
• Orbital floor repair: Surgery sometimes includes the repair of your orbital floor. However, some providers state the procedure isn’t necessary.

Can this be prevented?

Silent sinus syndrome is a condition that can affect anyone. Researchers aren’t sure of the cause of the condition, so there’s no way to prevent it.

What is the outlook (prognosis) for silent sinus syndrome?

The earlier you have silent sinus syndrome diagnosed, the better. You can avoid potential orbital complications and eliminate the need for surgery beyond endoscopic sinus surgery.

Without treatment, the condition can worsen and cause complications, including peripheral vision loss, double vision or blurred vision.

When should I see my healthcare provider?

You should see your healthcare provider if you have new symptoms including a sunken eye, droopy eyelid or displaced eyeball.

What questions should I ask my healthcare provider?

• How did I get silent sinus syndrome?
• What treatment do you recommend?
• Do I need surgery?
• What’s the recovery like after surgery?
• How can I prevent silent sinus syndrome from returning?

What is silent sinus syndrome also known as?

Other names for silent sinus syndrome include chronic maxillary atelectasis and imploding antrum syndrome, but some researchers consider those separate and distinct diseases.

A note from Cleveland Clinic

Silent sinus syndrome is a rare health condition in which a blockage in part of your sinuses causes a chain reaction of events that results in your sinuses sinking. This can have a great effect on your sinuses and your eyes. If you notice new symptoms such as drooping eyelids or sunken eyes, reach out to a healthcare provider to get a fresh look at what’s going on.