Clinical Findings in Symptomatic Patients With Radiologically Isolated Sphenoid Sinus Disease: A Systematic Review and Meta-Analysis.

Objective: To explore the clinical presentations of isolated sphenoid sinus disease (ISSD).

Setting And Design: A literature search was conducted on 23 December 2023 across electronic databases including Medline, Embase, Web of Science, and Cochrane. We performed a meta-analysis of proportions using a random-effects model to determine the prevalence of clinical findings in patients who presented with symptoms and had ISSD on radiological imaging. Sensitivity and subgroup analyses were employed to investigate sources of heterogeneity. The PRISMA guideline was followed.

Participants: This study included patients with clinically significant isolated sphenoid sinus opacification on cross-sectional imaging.

Main Outcome Measure: The pooled prevalence of clinical symptoms and signs.

Results: A total of 18 studies met the eligibility criteria, encompassing over 1000 patients. The prevailing symptoms were headache in 67.9% (95% CI 62.9-72.7), nasal symptoms 29.7% (95% CI 25.2-34.4), and visual disturbance 14.0% (95% CI 9.3-19.3). Subgroup analysis revealed a significant difference between neoplastic and inflammatory diagnoses concerning the development of visual symptoms (38.3% versus 15.5%, p = 0.0005). A negative nasendoscopic examination was found in 52.0% (95% CI 41.0-62.8) of cases.

Conclusions: Headache emerged as the primary symptom of ISSD, followed by nasal and visual symptoms. Nasendoscopy had a high false negative rate, highlighting its limitation in assessing this condition. Our study highlights the key clinical findings associated with ISSD, which may indicate the need for imaging.