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Sinus Surgery in Bone Marrow Transplantation Patients

Bone marrow transplantation (BMT) is used in the treatment of a wide range of malignancies. It involves immunosuppression and increased risk of infections such as sinusitis. However, the risk of infection is much higher in allogeneic transplants than those who are replaced with their own bone marrow (autologous). Immunodeficient patients may develop fungal sinusitis with a high mortality rate. An aggressive approach to evaluation and surgical intervention for fungal sinusitis in BMT patients at the Indiana University Medical Center was used for 2 years (from 1991 through 1992). This approach encouraged surgery on any BMT patient who was clinically septic or had any changes on a sinus CT scan. In 1993, a more medically oriented approach with radiologic and nasal endoscopic monitoring was adopted. During 1991 to 1992, 12 of the 21 allogeneic transplant patients (57%) who had sinus surgery died. The four autologous BMT patients operated on during this period all survived. Three allogeneic transplant recipients had surgery in 1993 and survived. No autologous cases had sinus procedures in 1993. No fungal sinus infection occurred in any BMT patient during the 3-year review. Careful patient selection, evaluation, and preventative measures can be successful in dealing with this rare but potentially fatal complication without performing unnecessary surgery on patients who have a poor prognosis unrelated to their sinuses.