Discussion
Organ transplantation is one of the most advanced and sophisticated treatment methods used by modern medicine. Developments in this field have made it necessary to plan and carry out pre-transplant and post-transplant care services to increase the treatment course. BMT, a type of organ transplantation, has also become the gold standard in the treatment of a certain group of hematological diseases [1]. Immunosuppressive treatments to prevent rejection applied after organ transplantation can lead to morbidity and treatment failures in many organ systems.
The ORL system is one of the systems where such problems are most common. Although there are studies on ORL complications that develop following various organ transplantations, we have not seen a study on ORI complications that develop during hospital isolation after BMT and their ENT consultations in the literature.
It has been reported that otological problems are seen after various organ transplantations. Ganzel et al reported 9% otological complications after cardiac transplantation patients, including infection origin, hearing loss and vertigo [5]. After kidney and liver transplantation otological problems reported as 17.7% including hearing loss, otalgia, tinnitus, vertigo, and ear bleeding [6]. Otological problems are not the most common type of ORL problems in those studies. In our study, otologic problems stand out as the most common ORL problem with 56% in the hospital isolation process after BMT. It was found to be the most common hearing loss among these otological problems. Because most of these losses were of neurosensorial type, patients were referred to hearing aids. It was thought that such high incidence of hearing loss was due to the deterioration of the hematological parameters of the drugs used for preparation for BTM and to provide immunosuppression after BTM, or the drugs themselves were ototoxic. In otological problems other than hearing loss, it was also attributed to the increase in infection risk and deterioration in blood values caused by the preparation for BTM and immunosuppressive therapy to prevent rejection after BTM.
Sinonasal problems are the most common and studied problems in organ transplant patients. Sinonasal problems in Cardiac transplant patients were found to be the most common ORL problem with 37%. Sinusitis is the most common type of sinonasal problem in these patients [5]. In addition, sinonasal problems in Liver and Renal transplantation patients were found to be the most common ORL problem with a rate of 41.5%. These patients have rhino sinusitis in the first place among the sinonasal problems, followed by epistaxis [6]. Various aspects of sinonasal problems in BMT patients have been addressed in studies. Sinusitis and its diagnostic and treatment strategies are among the most well-known and studied topics [4, 7-10]. In our study, sinonasal problems were found to be the second most common ORL problem with 26%. Although infection was the most common sinonasal problem in other studies [4, 7-10], we mostly dealt with epistaxis (87.5%). This difference seen in other studies can be explained by the fact that our period of seeing the patients in our study and including them in the study is limited to the hospitalization period in which the patients were isolated for BTM. Epistaxis seen in the early period of BMT treatment can be attributed to the deterioration in bleeding processes and damage to the nasal mucosa due to the radiotherapy and drug therapies used to suppress the bone marrow in preparation for BMT and to prevent rejection after BTM.
The oropharyngeal area is another anatomic ORL region affected after organ transplantation. ORL problems in the oropharyngeal area have been reported at a rate of 5% after cardiac transplantations [5]. Herpes and cytomegalovirus infections were often seen as oropharyngeal problems in these cardiac transplant patients [5, 11-13]. Oropharyngeal problems were reported in 36.3% of liver and renal transplant patients, with sore throat being the most common complaint [6]. Oropharyngeal problems in BMT patients have been reported with a high frequency of 80% in some review studies [14]. The majority of these are simple mucositis, which can be easily controlled and treated by the transplant team. The transplant team treated mild and uncomplicated mucositis so they were not consulted with us. Severe oropharyngeal problems consulted in our study were observed with a rate of 16%. All of these were infectious processes that the transplantation team could not cope with, and 20% of them were treated with surgical drainage.
Considering all ORL areas, almost all the ORL problems were found to be associated with morbidity, while not causing mortality in patients.
The value of this study is that patients’ ORL problems are identified and consulted during their hospitalization. For this reason, the probability of more reliable consequences is that the problems are less likely to cause misleading consequences, such as passing at home or going to other centers. Since the results are not the results of outpatients, but include problems before the patient is discharged in the acute period, it may provide a better idea to transplantation teams about what to consider in terms of ORL before BMT and what to expect after transplantation