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Sinonasal evaluation preceding hematopoietic transplantation.

Carl W Moeller1, James Martin, Kevin C Welch

  • 1Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois 60153, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
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Pre-transplant sinonasal evaluation before hematopoietic cell transplant (HCT) did not predict post-HCT complications. Routine sinonasal evaluation may not be cost-effective for all HCT candidates.

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Area of Science:

  • Hematology
  • Otolaryngology
  • Infectious Disease

Background:

  • Hematopoietic cell transplantation (HCT) is a critical procedure for various hematologic malignancies and other diseases.
  • Sinonasal complications can arise post-HCT, potentially impacting patient outcomes.
  • Pre-transplant sinonasal evaluation aims to identify and manage potential risks.

Purpose of the Study:

  • To assess the effectiveness of pre-HCT sinonasal evaluation.
  • To correlate pre-transplant sinonasal findings with the risk of post-HCT complications.
  • To analyze radiographic, endoscopic, and microbiologic data.

Main Methods:

  • A case series with chart review was conducted at an academic tertiary care center.
  • Seventy-one patients undergoing pre-HCT sinonasal evaluation were included.
  • Standardized scales were used for evaluating pre-HCT imaging (CT scans) and endoscopic exams, along with middle meatus cultures.

Main Results:

  • Most patients (65%) were asymptomatic pre-HCT, with low average Lund-Mackay and endoscopic scores.
  • Only 6% of patients had pre-HCT chronic rhinosinusitis, with successful medical or surgical treatment.
  • No patients developed rhinosinusitis post-HCT after pre-HCT intervention.
  • Two patients developed acute rhinosinusitis post-HCT without prior evidence of sinonasal issues.

Conclusions:

  • Pre-HCT medical or surgical interventions were indicated by symptomatic rhinosinusitis and positive imaging/endoscopy.
  • Post-HCT acute rhinosinusitis occurred in patients without pre-HCT sinonasal disease.
  • Pre-HCT sinonasal evaluation was not found to be predictive of post-HCT complications and may not be cost-effective.