Management of Paranasal Sinusitis in the Patient with Transplantation

Dhong, Hun Jong; Ryu, Jun Sun

Abstract

BACKGROUND AND OBJECTIVES: Recently there has been a marked increase in the number and the success rate of organ transplantation with the development of surgical technique and the introduction of new immunosuppressants. However, clinically silent sinonasal infections in transplant recipients frequently cause problems which are sometimes fatal. As otolaryngologists, we must give attention to sinonasal infection in these immunocompromised patients who have received organ transplantation. MAERIALS AND METHODS: We reviewed 170 patients who have received organ transplantation for three years and analyzed the clinical course of patients with sinonasal infection around the transplantation period. They were managed according to the protocol of our hospital.
RESULTS
There were 17 patients with sinonasal infection around transplantation. Four out of nine patients needed sinus operation before transplantation and six out of eight patients required operation after transplantation, and two of them had invasive fungal infection. Three out of four bone marrow transplant patients needed surgical management.
CONCLUSION
Immune status of the transplant patients was the most important prognostic factor. Before organ transplantation, when the patient's immune status is relatively normal, thorough and aggressive physical examination including OMU-CT is mandatory. OMU-CT plays the major role in the diagnosis of sinusitis and the treatment planning. Prompt decision-making and aggressive management are also thought to improve patients' outcome, especially after transplantation. We also propose a protocol that can be used for management of sinonasal infection in transplantation patients.