Sinonasal evaluation preceding hematopoietic transplantation

Objective. To determine the efficacy of sinonasal evaluation preceding hematopoietic cell transplant (HCT) and to correlate pretransplant findings with subsequent risk of post-HCT complications based on radiographic, endoscopic, and microbiologic findings. Study Design. Case series with chart review. Setting. Academic tertiary care center. Subjects and Methods. Seventy-one patients underwent pre-HCT sinonasal evaluation. Pre-HCT imaging and endoscopic exams were evaluated via standardized scales. Middle meatus culture results were also recorded. Pre-HCT intervention was noted, as was any post-HCT evaluation and intervention. Results. Seventy-one patients underwent pre-HCT evaluation. Sixty-five percent of patients were asymptomatic at the time of evaluation. On computed tomography (CT) imaging, the average Lund-Mackay score was 2.2 ± 3.7. Mean endoscopic grading score was 0.6 ± 1.6. The majority of cultures grew commensal organisms only. Four of 71 patients (6%) had evidence of chronic rhinosinusitis pre-HCT; 3 patients underwent endoscopic sinus surgery, and 1 patient was treated medically. None developed rhinosinusitis following HCT. Four different patients were evaluated for sinonasal symptoms post-HCT. Two were diagnosed with acute rhinosinusitis: 1 was treated medically, and 1 was treated surgically. No patient developed invasive fungal sinusitis. Conclusions. All patients who required pre-HCT medical or surgical intervention had symptoms of rhinosinusitis and positive endoscopy and/or CT imaging. Two patients who developed acute rhinosinusitis post-HCT had no evidence of rhinosinusitis during pre-HCT evaluation. Evaluation and studies are costly, time-consuming, and not found to be predictive in this study.