Role of Desert Climate in Bisha City on Chronic Sinusitis Symptoms and Risk Factors ()
1. Introduction
Chronic sinusitis is a significant health problem worldwide, affecting almost 15% of people [1], with a prevalence rate reported to be between 6% and 27.1% [1] [2]. The eastern province of Saudi Arabia has a higher prevalence of chronic rhinosinusitis [3], and there has been a noticeable rise in this condition nationwide. The paranasal sinuses include the maxillary, frontal, sphenoidal, and ethmoidal sinuses. They begin as diverticula from the nasal mucosa at birth, develop further after the eruption of permanent teeth, and reach full development in adolescence [4]. Inflammation of the lining membranes of one or more sinuses is called sinusitis or rhinosinusitis [1]. Sinusitis is caused by various inflammatory factors, including pathophysiology, which obstruct the sinus cavity and lead to infection and chronic inflammation [5]. It is diagnosed by identifying two symptoms from a range of symptoms lasting for 12 consecutive weeks. These symptoms can include facial pressure, fullness or pain, nasal obstruction, headache, clear or mucopurulent nasal discharge, and hypo or anosmia [6]. Chronic sinusitis symptoms can last up to 90 days, with or without severe flare-ups [5]. It is associated with significant medical treatment costs, decreased workplace productivity, and a substantially reduced quality of life [7]. The socioeconomic burden of chronic sinusitis was recognized in 1996, with a direct cost of $5.8 billion [8]. Bisha is situated in the southwestern region of Saudi Arabia and is known for its desert climate, characterized by hot summers and mild winters. Despite the high prevalence of chronic rhinosinusitis (CRS), there is a lack of comprehensive data on its true occurrence, especially across various demographic groups and geographic regions. The high frequency, impact on quality of life, and financial cost of CRS make it a serious public health concern. However, to our knowledge, no previous study has explored the distribution of CRS among people in Bisha. Focusing on Bisha is crucial due to its unique desert climate, which may exacerbate CRS through increased dust exposure and allergens. Additionally, the region’s demographic diversity may reveal varying susceptibility to CRS, highlighting the need for targeted public health interventions. This study aimed to estimate the prevalence of CRS and its risk factors among people in Bisha.
2. Materials and Methods
This cross-sectional study was conducted in Bisha, Saudi Arabia, from November 2024 to January 1, 2025. Using an electronic sample size calculator, we determined that the minimum required sample size was 384 participants, based on a 5% margin of error and a 95% confidence interval.
The questionnaire was distributed online through social media, utilizing the author’s professional networks, friends, and family, allowing any viewer to respond voluntarily in Bisha City. We included adult participants aged 18 years and above, living in the Bisha province and its surrounding areas. We excluded those who refused to participate. Data collection included questions about the general and demographic information of the respondents and questions assessing the risk factors that may affect the development of CRS. The questionnaire also included questions assessing the score of sinus symptoms of sinusitis using a GA2LEN, validated Arabic self-reported 6-item questionnaire, adapted from the work of Albaharna H et al. [9], which assessed chronic sinusitis prevalence. Each question assessing the score of sinus symptoms was scored with 1 point, and a total score of 4 points or more was considered indicative of CRS.
The collected data was coded, entered, and analyzed using the Statistical Package for the Social Sciences (SPSS) version 23. The chi-square test and multiple logistic regressions were applied to determine the statistical significance of associations, with p-values of 0.05 or less considered statistically significant.
3. Results
A total of 416 participated in the study, with 299 (71.9%) female and 117 (28.1%) male. The mean age was 29.5 years, and the mean BMI was 25.28. Out of all participants, 81 (19.47%) were found to have CRS. Table 1 shows the sociodemographic data of the study population and its association with CRS. Marital status and place of residence were statistically significant (P = 0.011 and P = 0.001, respectively). Body mass index (BMI) was significantly associated with CRS (P = 0.012).
Table 1. Sociodemographic data and its association with CRS.
Sociodemographic |
Category |
Frequency N = 416 (%) |
CRS N (%) |
Chi-square test (N 416) |
P-value |
Age |
18 - 30 years old |
265 (63.7) |
43 (16.2) |
7.272 |
0.064 |
31 - 40 years old |
79 (19) |
19 (24.1) |
41 - 50 years old |
57 (13.7) |
13 (22.8) |
More than 50 years old |
15 (3.6) |
6 (40.0) |
Gender |
Male |
117 (28.1) |
27 (23.1) |
1.350 |
0.245 |
Female |
299 (71.9) |
54 (18.1) |
Nationality |
Saudi |
411 (98.8) |
81 (19.7) |
1.224 |
0.269 |
Non-Saudi |
5 (1.2) |
0 (0) |
Marital status |
Married |
169 (40.6) |
39 (23.1) |
11.237 |
0.011* |
Single |
238 (57.2) |
39 (16.4) |
Divorced |
7 (1.7) |
1 (14.3) |
Widow |
2 (0.5) |
2 (100) |
Educational level |
Bachelor |
294 (70.7) |
56 (19.0) |
1.897 |
0.594 |
Diploma |
38 (9.1) |
6 (15.8) |
Postgraduate studies |
15 (3.6) |
2 (13.3) |
High school or less |
69 (16.6) |
17 (24.6) |
Job status |
Employee |
141 (33.9) |
35 (24.8) |
6.728 |
0.081 |
Unemployed/ Retired |
84 (20.2) |
13 (15.5) |
Student |
180 (43.3) |
29 (16.1) |
Freelance |
11 (2.6) |
4 (36.4) |
Place of residence |
Bisha Governorate |
368 (88.5) |
61 (16.6) |
17.048 |
0.001* |
Villages of Bisha Governorate |
48 (11.5) |
20 (41.7) |
Income (per month) |
<5000 SAR |
246 (59.1) |
40 (16.3) |
7.515 |
0.057 |
5000 - 10,000 SAR |
64 (15.4) |
11 (17.2) |
10,001 - 15,000 SAR |
59 (14.2) |
18 (30.5) |
>15,000 SAR |
47 (11.3) |
12 (25.5) |
BMI |
<18.5 Under weight. |
39 (9.4) |
4 (10.3) |
10.883 |
0.012* |
18.5 - 24.9 Normal weight |
179 (43.1) |
28 (15.6) |
25 - 29.9 Overweight |
114 (27.4) |
23 (20.2) |
30 or more, Obese |
84 (20.2) |
26 (31.0) |
*Statistically significant. CRS stands for chronic rhinosinusitis. BMI stands for body mass index.
Table 2. Allergens and risk factors and their association with CRS.
Variables |
Category |
No CRS %) |
CRS N (%) |
Chi-Squared test N (416) |
P-value |
Exposure to pets |
Yes |
52 (65.8) |
27 (34.2) |
13.45 |
0.001* |
No |
283 (84.0) |
54 (16.0) |
Exposure to
detergents |
Yes |
139 (76.8) |
42 (23.2) |
12.848 |
0.091 |
No |
206 (87.7) |
29 (12.3) |
Exposure to dust and plants |
Yes |
183 (74.1) |
64 (25.9) |
16.081 |
0.001* |
No |
152 (89.9) |
17 (10.1) |
Exposure to gases and smoke |
Yes |
84 (64.1) |
47 (35.9) |
32.826 |
0.001* |
No |
251 (88.1) |
34 (11.9) |
Exposure to
humid environment |
Yes |
56 (82.4) |
12 (17.6) |
0.172 |
0.678 |
No |
279 (80.2) |
69 (19.8) |
Smoking |
Yes |
24 (64.9) |
13 (35.1) |
6.355 |
0.012* |
No |
311 (82.1) |
68 (17.9) |
DM |
Yes |
14 (63.6) |
8 (36.4) |
4.227 |
0.040* |
No |
321 (81.5) |
73 (18.5) |
HTN |
Yes |
20 (74.1) |
7 (25.9) |
0.767 |
0.381 |
No |
315 (81.0) |
74 (19.0) |
Seasonal flu vaccine |
Yes |
96 (82.8) |
20 (17.2) |
0.51 |
0.475 |
No |
239 (79.7) |
61 (20.3) |
Deviated nasal
septum |
Yes |
39 (62.9) |
23 (37.1) |
14.435 |
0.001* |
No |
296 (83.6) |
58 (16.4) |
Asthma |
Yes |
26 (59.1) |
18 (40.9) |
14.422 |
0.001* |
No |
309 (83.1) |
63 (16.9) |
*Statistically significant. CRS stands for chronic rhinosinusitis. DM stands for diabetes millets. HTN stands for hypertension.
In terms of allergen exposure, 79 (19%) participants were exposed to pets, 181 (43.5%) to detergents, 247 (59.4%) to dust and plants, 131 (31.5%) to gases and smoke, and 68 (16.3%) to a humid environment. Allergen exposure was significantly associated with CRS for pets, dust and plants, and gases and smoke exposure (P = 0.001). Of the total population, only 37 (8.9%) were smokers, and smoking was significantly associated with CRS (P = 0.012). Additionally, 116 (27.9%) had completed their seasonal influenza vaccines.
In terms of chronic diseases, 22 (5.3%) have DM, 27 (6.5%) have HTN, 62 (14.9%) have a deviated nasal septum, and 44 (10.6%) have asthma. Chronic diseases significantly associated with CRS include diabetes mellitus (P = 0.040), deviated nasal septum (P = 0.001), and asthma (P = 0.001), as shown in Table 2.
The logistic regression analysis was conducted to investigate the risk factors associated with CRS. The results, summarized in Table 3, highlight several significant associations.
Table 3. Logistic regression analysis for risk factors associated with CRS.
Variables |
Estimate (β) |
Odds Ratio (OR) |
95% confidence intervals (CI) Lower-upper |
p-value |
BMI |
0.064 |
1.066 |
1.025 - 1.109 |
0.02 |
Exposure to pets (yes vs No) |
1.001 |
2.721 |
1.572 - 4.709 |
<0.001 |
Exposure to detergents (yes vs No) |
0.418 |
1.519 |
0.933 - 2.471 |
0.093 |
Exposure to dust and plants (yes vs No) |
1.140 |
3.127 |
1.757 - 5.565 |
<.001 |
Exposure to humid environment (yes vs No) |
−0.143 |
0.866 |
0.440 - 1.705 |
0.678 |
Exposure to gases and smoke (yes vs No) |
1.418 |
4.131 |
2.491 - 6.849 |
<0.001 |
Do you smoke? (yes vs No) |
0.907 |
2.477 |
1.201 - 5.111 |
0.014 |
Do you have diabetes? (yes vs No) |
0.921 |
2.513 |
1.016 - 6.212 |
0.046 |
Have you completed your seasonal flu vaccine? (yes vs No) |
0.203 |
1.225 |
0.701 - 2.140 |
0.476 |
Do you have high blood pressure? (yes vs No) |
0.399 |
1.490 |
0.607 - 3.654 |
0.384 |
Do you have deviated nasal
septum? (yes vs No) |
1.102 |
3.010 |
1.673 - 5.414 |
<0.001 |
Do you have asthma? (yes vs No) |
1.222 |
3.396 |
1.756 - 6.565 |
<0.001 |
CRS stands for chronic rhinosinusitis. BMI stands for body mass index.
Participants with a high BMI were significantly more likely to develop CRS (OR = 1.066, 95% CI: 1.025 - 1.109, P = 0.02). Adults exposed to pets had a higher risk of developing CRS (OR = 2.721, 95% CI: 1.572 - 4.709, P = 0.001). The risk also increased with exposure to dust and plants (OR = 3.127, 95% CI: 1.757 - 5.565, P = 0.001) and gases and smoke (OR = 4.131, 95% CI: 2.491 - 6.849, P = 0.001). Smoking was a risk factor for CRS (OR = 2.477, 95% CI: 2.491 - 6.849, P = 0.001). The findings indicated that diabetes increased the risk of CRS (OR = 2.513, 95% CI: 1.016 - 6.212, P = 0.046). Adults with nasal septum deviation were significantly more likely to develop CRS (OR = 3.010, 95% CI: 1.673 - 5.414, P = 0.001). Participants with asthma also had a significantly higher likelihood of having CRS (OR = 3.396, 95% CI: 1.756 - 6.565, P = 0.001). The responses from the 6-item questionnaire assessing sinus symptom scores are presented in Table 4.
Table 4. Questionnaire items and population responses.
Question |
Response |
Portion |
Have you ever been diagnosed with chronic sinusitis? |
92 |
22.12% |
Do you have any nasal allergies, such as hay fever? |
120 |
28.85% |
Have you experienced nasal congestion for more than 12 weeks in the past year? |
125 |
30.05% |
Have you felt pain or pressure around your forehead, nose, or eyes for more than 12 weeks in the past year? |
133 |
31.97% |
Have you noticed a change in the color of your nasal discharge or throat mucus for more than 12 weeks in the past year? |
92 |
22.12% |
Have you had a decreased or lost sense of smell for more than 12 weeks in the past year? |
90 |
21.64% |
4. Discussion
Healthcare costs related to chronic rhinosinusitis are notably higher compared to conditions such as acute asthma, resulting in an average of 5.79 workdays lost [10]. Undiagnosed chronic rhinosinusitis can significantly impact an individual’s quality of life. Survey studies can estimate its prevalence, highlighting the importance of regular sinus check-ups to prevent negative outcomes.
In 2021, a large online survey conducted in Saudi Arabia involved 4963 subjects. The study found that the prevalence of chronic rhinosinusitis (CRS) was 22.5%, indicating a high occurrence of CRS, particularly among older females, individuals with chronic conditions, and those exposed to risk factors such as smoking [11]. In the ongoing study of Bisha City’s general population, 47% were found to have CRS. Although no significant association was found, CRS frequency was higher in female participants. Allergen exposure, such as pets, dust, plants, gases, smoke (P = 0.001), and smoking (P = 0.005), was significantly associated with CRS. This aligns with findings by Alhazmi WA et al. [11] and Homood MA et al. [12], where these factors were shown to be a high risk for developing CRS.
In the current study, CRS was found to be slightly higher in individuals younger than 30 years, although this association was not statistically significant. CRS was statistically significant in married individuals and those residing in urban areas (P = 0.011 and P = 0.001, respectively). These findings are contrary to Homood MA et al. [12], which found CRS was more prevalent among the young and those living in rural areas, and less prevalent among married individuals.
Asthma was found to be associated with CRS (P = 0.001), and CRS was less prevalent in asthmatic patients than in the general population. A study conducted in 2022 among asthmatic patients in Saudi Arabia found that the prevalence of rhinosinusitis among individuals with asthma was low [13].
In the study conducted by Hakami NA et al. [14] in Jazan in 2020, no significant relationship was found between diabetes mellitus and hypothyroidism with CRS. This finding contradicts our study, which found a significant association between diabetes mellitus and CRS (P = 0.017).
According to the findings, hypertension does not appear to be associated with the prevalence of CRS disease (P > 0.05). However, a cross-sectional study involving 52,992 subjects reported that sinusitis is linked with hypertension only in women [15].
In the clinical evaluation of patients with chronic rhinosinusitis (CRS), it is essential to recognize the multifactorial nature of the disease, encompassing various phenotypes. Furthermore, considering the presence of obesity is important when assessing individuals with CRS [16]. A high body mass index has been shown to be associated with CRS (P = 0.012) and is considered a high-risk factor, possibly related to a sedentary lifestyle. This finding was supported by a meta-analysis conducted in 2024, which indicated a positive association between overweight, obesity, and CRS [17].
In our study, the risk of CRS increased in participants with deviated nasal symptoms. Deviated nasal symptoms were studied by Orlandi RR [18], who concluded that septal deviation is linked to an increased prevalence of rhinosinusitis.
Clinical research indicates that pollutants may significantly exacerbate disease severity in specific demographic groups. However, their influence on the incidence or prevalence of chronic rhinosinusitis (CRS) remains uncertain [19].
Bisha is known for its desert climate, which contributes to the high exposure to dust in our study participants. Prolonged exposure to arid environments may aggravate sinusitis, leading to inflammation and irritation of the sinus passages. This could explain the relative increase in CRS in our study population.
5. Limitations
This study is limited by a small number of representative samples of Bisha people, and the findings cannot be generalized to the total population of Saudi Arabia since Bisha city is known for its desert climate, which could increase prevalence in this specific population. Survey-validated tools can assess the current prevalence of certain diseases; however, self-reported data can be subjective and prone to recall bias. A complete history, examination, and investigation are required to determine the actual prevalence of CRS.
6. Conclusion
This study highlights the significant prevalence of chronic rhinosinusitis (CRS) in Bisha City, especially among married individuals and those with chronic conditions. Risk factors such as environmental allergen exposure, smoking, obesity, and deviated nasal symptoms are linked to a higher risk of CRS. The desert climate and dust exposure in Bisha seem to exacerbate the prevalence of CRS. Recognizing these associations is essential for healthcare providers to develop targeted prevention and management strategies.
Consent to Participate
Informed consent was obtained from all participants.
Ethical Approval
Ethical approval was obtained from King Abdullah Hospital in Bisha City, Saudi Arabia, via reference number E-CTS REF No. BIS-24-00019, dated: 23-10-2024.