Silent Sinus Syndrome Treatment in Singapore

Silent sinus syndrome can develop gradually without obvious symptoms, making it challenging to identify until facial changes become noticeable. This condition affects the maxillary sinus and may lead to facial asymmetry if left unaddressed. Understanding the signs and available treatment options is important for timely intervention. ENT specialists in Singapore provide comprehensive evaluation and management of silent sinus syndrome using modern diagnostic techniques and established surgical approaches to restore function and facial symmetry.

*Individual results and treatment outcomes may vary.*

Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

Image Whisk_1c1c676ffa4314a904249a32208682b6dr

Overview Causes Symptoms When To See an ENT Specialist Diagnosis Treatment Complications Prevention FAQ

What is Silent Sinus Syndrome?

Silent sinus syndrome, also known as chronic maxillary atelectasis, is a rare condition where the maxillary sinus (located in the cheekbone area) gradually collapses. This collapse occurs due to chronic negative pressure within the sinus, causing the sinus walls to contract inward. The condition may affect one side of the face and develop slowly over months or years.

Despite its name suggesting no symptoms, patients may experience subtle changes that could go unnoticed initially. The syndrome can affect adults, with no significant gender preference. In Singapore and Asia, the condition remains underdiagnosed due to its gradual onset and subtle early presentation.

Causes & Risk Factors

Causes

Silent sinus syndrome occurs when the maxillary sinus ostium (natural drainage opening) becomes blocked. This creates negative pressure within the sinus cavity as air gets absorbed but cannot be replaced. The sustained negative pressure causes the sinus walls to collapse inward. Common underlying causes include:

Chronic inflammation of the sinus lining
Anatomical variations affecting sinus drainage
Previous sinus infections, which may lead to scarring
Mucosal thickening blocking the ostium
Spontaneous ostial obstruction without apparent cause

Risk Factors

Several factors may increase the likelihood of developing silent sinus syndrome:

History of chronic sinusitis or recurrent sinus infections
Previous facial trauma affecting the sinus region
Anatomical variations such as a deviated septum
Chronic allergic rhinitis causing persistent inflammation
Previous sinus surgery with altered anatomy
Smoking, which affects sinus mucosa health
Immunocompromised states affecting sinus function

Signs & Symptoms

Early Symptoms

Subtle facial asymmetry on the affected side
Mild sensation of facial pressure or fullness
Occasional eye discomfort without vision changes
Slight deepening of the upper eyelid fold

Progressive Symptoms

Noticeable sinking of the eye (enophthalmos)
Visible facial asymmetry is becoming more apparent
Double vision (diplopia), especially when looking up
Increased tear production on the affected side
Cheek numbness or altered sensation
Cosmetic concerns about facial appearance

Advanced Symptoms

Eye displacement downward and inward
Double vision that may affect daily activities
Facial deformity
Eye irritation and dryness
Difficulty with eye movement
Emotional impact from facial changes

Silent sinus syndrome typically progresses slowly. Patients may seek medical attention when cosmetic changes become apparent or when visual symptoms develop.

Experiencing these symptoms?

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When To See an ENT Specialist

Seek medical evaluation if you notice gradual changes in facial symmetry, particularly around the eye area. Immediate consultation is recommended if you experience sudden-onset double vision, significant eye displacement, or rapid facial changes. Assessment is essential even for subtle symptoms, such as mild facial pressure or occasional eye discomfort on one side.

During your first consultation, an ENT specialist may conduct a thorough examination, including nasal endoscopy to visualise the sinus openings. The consultation involves discussing your symptom timeline, medical history, and any previous sinus issues. Imaging studies may be arranged to confirm the diagnosis and assess the extent of sinus collapse.

Intervention may help prevent the progression of facial deformity and can aim to achieve improved surgical outcomes. Delaying treatment may result in permanent bone changes requiring more complex reconstruction procedures.

*Individual results and timelines may vary.*

Diagnosis & Testing Methods

Diagnosis of silent sinus syndrome involves a combination of clinical examination and imaging studies. The diagnostic process begins with detailed history taking, focusing on symptom progression and timeline.

Physical Examination

Physical examination includes assessment of facial symmetry, eye position, and eye movement. Nasal endoscopy allows direct visualisation of the middle meatus, where the maxillary sinus drains. This procedure uses a thin, flexible camera to examine the nasal passages and the openings of the sinuses.

CT Scan

A CT scan of the sinuses can help show the collapsed maxillary sinus, opacification of the sinus cavity, and inward bowing of sinus walls. The scan may also reveal a lateralised uncinate process and an enlarged middle turbinate, which can be associated with this condition. MRI may be requested to evaluate orbital contents and rule out other pathologies.

Ophthalmology Consultation

Ophthalmology consultation is often arranged to assess eye position and document any visual field defects. Measurements of eye position (exophthalmometry) can document enophthalmos.

*Individual results and findings may vary.*

Treatment Options Overview

Medical Management

Initial medical therapy focuses on reducing inflammation and improving sinus drainage. Nasal corticosteroid sprays may help reduce mucosal swelling and could temporarily improve symptoms. Saline irrigations help clear mucus and maintain nasal hygiene. Oral antibiotics may be prescribed if concurrent infection is present. Medical management alone cannot reverse the structural changes, but may help optimise conditions before surgery.

Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) is a treatment option for silent sinus syndrome. This minimally invasive procedure aims to reopen the blocked maxillary sinus ostium to restore normal sinus ventilation. The surgery involves removing obstructing tissue, widening the natural drainage pathway, and working towards long-term patency. The procedure is performed through the nostrils without external incisions, utilising high-definition cameras and specialised instruments.

Maxillary Sinus Re-aeration

Following ostium opening, the collapsed sinus may gradually re-expand as normal air pressure returns. This natural re-aeration process can occur over several weeks to months. Some cases may require placement of temporary balloon catheters to assist sinus re-expansion. Regular follow-up helps in adequate healing and monitors sinus recovery.

Orbital Floor Reconstruction

Cases with significant eye displacement may require orbital floor reconstruction. This procedure involves placing implants to support the orbital floor and aims to restore normal eye position. Materials used include titanium mesh, porous polyethene, or resorbable plates. The surgery can be performed simultaneously with sinus surgery or as a staged procedure, depending on individual circumstances.

Post-Surgical Care

Recovery involves regular nasal irrigation to help prevent scarring and maintain sinus drainage. Topical medications may help reduce inflammation during the healing process. Serial endoscopic examinations help keep the sinus ostium open. Patients may experience gradual improvement in facial symmetry over several months as the sinus re-expands.

Every patient’s condition is unique.

Our ENT specialist will assess your specific situation and recommend the appropriate treatment.

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Complications if Left Untreated

Without treatment, silent sinus syndrome may progressively worsen, potentially leading to facial changes. The ongoing sinus collapse can cause bone remodelling of the orbital floor and maxillary walls. Chronic eye displacement may result in double vision that could affect quality of life and potentially limit driving or work capabilities.

Untreated cases may develop chronic orbital complications, including restricted eye movement and corneal exposure problems. The psychological impact of facial asymmetry can be significant, potentially affecting self-esteem and social interactions. Some patients may develop secondary sinusitis due to impaired drainage.

Long-term complications may include enophthalmos (sunken eye) that could require reconstructive surgery. Chronic inflammation may extend to adjacent sinuses, potentially causing pansinusitis. Vision changes can occur from orbital nerve compression or vascular compromise.

Prevention

Whilst silent sinus syndrome cannot always be prevented, specific measures may help reduce risk. Prompt treatment of sinus infections may help prevent chronic inflammation and scarring that could obstruct sinus drainage. Managing allergic rhinitis effectively may help reduce chronic nasal and sinus inflammation.

Avoiding smoking can help protect sinus mucosa health and maintain normal ciliary function for sinus drainage. Regular follow-up after sinus surgery helps with early detection of drainage problems. Maintaining good nasal hygiene through saline irrigation may help prevent mucus accumulation.

Addressing anatomical issues, such as severe septal deviation, may help prevent sinus drainage problems. Early evaluation of facial asymmetry or changes in eye position allows timely intervention before progression.

*Individual results and outcomes may vary.*

For Singaporeans & Singapore Permanent Residents

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Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.

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Frequently Asked Questions (FAQ)

How quickly does silent sinus syndrome progress?

Silent sinus syndrome typically develops gradually over several months to years. The rate of progression varies among individuals, with some experiencing slow changes over many years, whilst others notice more rapid development over months. Early stages may go unnoticed due to subtle symptoms. Once facial asymmetry becomes apparent, progression may seem to accelerate, though this often reflects increased awareness rather than actual acceleration. Regular monitoring helps track progression rate and determine optimal timing for intervention.

Will my facial appearance return to normal after surgery?

Surgical outcomes depend on the severity and duration of the condition before treatment. Early intervention may improve facial symmetry. The maxillary sinus may re-expand over several months following surgery, potentially leading to gradual improvement in eye position. Complete restoration to pre-condition appearance may not always be achievable in advanced cases with significant bone remodelling. Your ENT specialist can discuss realistic expectations based on your specific presentation during consultation.

*Individual results and timelines may vary.*

Is silent sinus syndrome painful?

Silent sinus syndrome is characteristically painless, which contributes to delayed diagnosis. Most patients experience no pain despite significant anatomical changes occurring. Some may report mild pressure sensation or fullness on the affected side. The absence of pain distinguishes this condition from acute sinusitis or other inflammatory sinus conditions. Any significant pain may prompt evaluation for other concurrent conditions that may require additional treatment.

Can silent sinus syndrome affect both sides of the face?

Silent sinus syndrome typically affects only one maxillary sinus, resulting in unilateral facial changes. Bilateral involvement is extremely rare but has been reported in medical literature. Most cases show clear asymmetry between the affected and normal sides. If both sides appear affected, alternative diagnoses can be considered.

What is the success rate of endoscopic surgery for this condition?

Functional endoscopic sinus surgery can reopen the blocked sinus drainage when performed by experienced surgeons. The procedure aims to halt disease progression and allow sinus re-aeration. Cosmetic improvement varies depending on pre-existing changes and individual healing responses. Revision surgery is occasionally needed if scarring occurs at the surgical site.

How long is the recovery period after surgery?

Initial recovery from endoscopic sinus surgery may take one to two weeks, during which time you may experience nasal congestion and mild discomfort. Most patients may return to normal activities within two weeks. Complete healing of the sinus lining may occur over six to eight weeks. Facial symmetry improvement may continue gradually over several months as the sinus re-expands. *Individual results and timelines may vary.* Regular follow-up appointments monitor healing progress and optimal recovery.

Conclusion

Silent sinus syndrome, though rare, is a condition that may be managed with timely recognition and appropriate surgical intervention. The gradual nature of this condition often leads to delayed diagnosis, but understanding the subtle signs can facilitate earlier treatment. Modern endoscopic techniques may offer effective management options with minimal invasiveness when performed by ENT specialists. The approach to management involves accurate diagnosis, appropriate surgical planning, and careful post-operative monitoring to support sinus re-expansion and facial symmetry restoration.

Take the First Step Towards Better Health

Living with silent sinus syndrome can be challenging, but you don’t have to face it alone. Our ENT specialist has experience in diagnosing and managing silent sinus syndrome using current evidence-based approaches.

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Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.

Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.

2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
2016 – Best Educator Award (Eastern Health Alliance)
2016 – “Wow” Award (Patient Compliment)

2014 – Eastern Health Alliance Caring Award – Silver
2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
2012 – Human Manpower Development Award (Ministry of Health, Singapore)
2007 – Singhealth Best Doctor Award

Qualifications

MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
FAMS – Fellow of the Academy of Medicine Singapore

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Mount Elizabeth Novena Hospital
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