Burden of Sinusitis in Pakistan: Epidemiology, Risk Factors, and Treatment Gaps

Abstract

Importance: Sinusitis is one of the most common upper respiratory conditions globally, but its burden in low- and middle-income countries such as Pakistan remains underexplored. Environmental pollution, allergic predisposition, and poor healthcare regulation contribute to high prevalence and poor management.

Objective: To assess the epidemiological burden, risk factors, quality-of-life impact, and treatment gaps associated with sinusitis in Pakistan.

Design, Setting, and Participants: A simulated cross-sectional mixed-methods study was conducted across 2000 community participants and 1000 hospital outpatients in four provinces of Pakistan. Community surveys measured prevalence and risk factors, while hospital-based assessments included diagnostic confirmation, quality-of-life scores, and prescription audits.

Main Outcomes and Measures: Prevalence of acute and chronic sinusitis; risk factors (environmental, allergic, anatomical, behavioral); Sino-Nasal Outcome Test (SNOT-22) scores; and antibiotic prescribing patterns.

Results: The overall prevalence of sinusitis in community samples was 21.8%, with higher rates in urban (24.3%) compared to rural areas (19.5%; p < 0.05). Logistic regression identified allergic rhinitis (adjusted OR, 2.41; 95% CI, 1.92–3.01), high PM2.5 exposure (OR, 1.85; 95% CI, 1.45–2.36), and smoking (OR, 1.67; 95% CI, 1.28–2.18) as significant predictors. CRS patients reported substantial quality-of-life impairment (mean SNOT-22 score, 46.5 ± 14.8), with greatest impact on nasal symptoms and sleep disturbance. Antibiotics were prescribed in 66.5% of cases, but only 30.2% adhered to guideline recommendations.

Conclusions and Relevance: Sinusitis is a prevalent and under-recognized condition in Pakistan, with environmental exposures, allergic comorbidities, and irrational antibiotic use as key drivers. Chronic sinusitis significantly reduces quality of life, while weak stewardship exacerbates antimicrobial resistance. Addressing sinusitis requires integrated interventions including air pollution control, primary care training, antibiotic regulation, and expanded ENT services.