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