[Oto-rhino-laryngological diseases in patients with advanced kidney failure after kidney transplantation]

Within a period of 7 years a total of 113 patients could be oto-rhino-laryngologically examined. The cases comprise chronic uremic patients under conservative therapy, patients with chronic intermittent haemodialysis treatment, and patients after successful renal transplantation. In 52% of all patients examined an impairment of hearing can be diagnosed and specified as inner ear deafness. As common etiological factors for inner ear deafness can be excluded, an accumulation of so-called uremic toxins is regarded to be the most probable cause of uremic deafness. This is confirmed by the fact that uremic deafness is not affected by haemodialysis treatment, but can be influenced favorably by a normal transplant function. Besides infiltrations of chronic inflammation and metaplasia of epithelium, nasal biopsies on uremic patients yielded histological findings invariably showing wide, thin-walled vessels in the subepithelium and the stroma. This phenomenon is possibly another pathogenic factor for epistaxis in chronic uremic patients. The depression of immunological resistance in uremia and the medication of immunosuppressive drugs after renal transplantation may explain the fact that serious otorhino-laryngological injections could frequently be observed in our patients. Careful observation may be helpful for early diagnosis and treatment of possible bacterial and mycotic infections in a very early stage.