Abstract
OBJECTIVE
1) To recognize pretransplant risk factors predisposing bone marrow transplant patients to sinonasal complications based on radiographic, endoscopic, and microbiologic findings, and 2) To correlate pretransplant finding with subsequent risk of complications.
METHOD
A retrospective review of all patients who underwent pretransplant sinonasal evaluation prior to allogenic hematopoietic transplantation was completed. Pretransplant CT scans and endoscopic exams were evaluated via standardized scales (Lund-Mackay and endoscopic grading score, respectively). Sinonasal culture results were also recorded. Any pretransplant medical or surgical intervention was noted, as was any posttransplant sinonasal complication and subsequent intervention. Correlation between pretransplant findings and subsequent sinonasal disease was analyzed.
RESULTS
Eight-two patients underwent pretransplant evaluation. 53% of patients were asymptomatic at time of evaluation, while 16% complained of rhinorrhea, 8% of nasal congestion, and 6% of facial pressure. 24 of 82 patients (29.3%) underwent CT imaging, with an average Lund-Mackay score of 2.2 out of 28. 82 of 82 patients (100%) underwent endoscopic evaluation, with a mean endoscopic grading score of 0.6 out of 20. Of 42 culture specimens, 30 grew coagulase-negative Staphylococcus, 7 grew Corynebacterium, 7 grew Staphylococcus Aureus, and 5 grew Streptococcus Viridans. 4 of 82 patients (4.9%) had evidence of rhinosinusitis on evaluation, three of which underwent endoscopic surgery and one of which was treated with antibiotic and oral steroids. None of these patients developed subsequent sinonasal complications following transplantation. 5 of 82 patients (6.1%) were evaluated for sinonasal symptoms following transplantation. One was treated for uncomplicated acute sinusitis. Only one required surgery for a complicated acute sinusitis. The overall incidence of acute or chronic invasive fungal sinusitis was 0%.
CONCLUSION
Pretransplant imaging, endoscopy, and culture results are not predictive of subsequent sinonasal complications during hematopoietic cell transplantation. All patients who underwent pretransplant medical or surgical intervention had AAOHNS/SAHP criteria for sinusitis elicited during a routine medical interview. Furthermore, the two patients who did develop sinonasal disease following transplantation had no evidence of disease during pretransplant evaluation. Studies are costly, time-consuming, potentially harmful, and of limited utility in absence of symptoms. Therefore, a standard history and physical examination should be sufficient in the pretransplant setting, and patients with symptoms of sinusitis should be referred to an otolaryngologist for further work-up and management.