Risk Factors in the Development of Acute Sinusitis in Immunocompromised Patients

Abstract

Twenty-six patients diagnosed as having hematologic neoplasms were evaluated clinically and radiographically for the presence of sinus disease before receiving immunosuppressive therapy. Evaluations included basic clinical information, a thorough otolaryngologic history and endoscopic examination of the nasal cavity. Plain sinus films and paranasal sinus computed tomography (CT) scans were obtained on all patients. These patients were then followed for 1 year. Ten patients ultimately developed acute sinusitis, as documented by their symptoms and by CT scan: five of these patients required surgery, and three ultimately died. Potential risk factors for sinusitis were analyzed statistically. We found a significant correlation between preimmunosuppression CT scans indicating either chronic sinusitis or anatomic abnormalities and the development of sinusitis. Also multiple anatomic abnormalities on endoscopic diagnostic nasal examinations tended to identify individuals susceptible to sinusitis. Such patients who subsequently became neutropenic and had acute episodes of sinusitis tended to have a poor outcome. Those who developed fungal sinus infections were prone to have a fatal outcome. This study suggests that patients with hematologic neoplasms who are susceptible to the development of acute sinusitis should be identified before receiving immunosuppressive chemotherapy.