Skip to main content
SpringerLink
Log in

Posttransplant sinus surgery in lung transplant recipients with cystic fibrosis: a single institutional experience

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Chronic rhinosinusitis is hypothesised to play a major role in lung transplant recipients with cystic fibrosis. Paranasal sinuses are considered to accumulate a significant bacterial load, potentially leading to lung allograft infection with ensuing complications such as bronchiolitis obliterans syndrome, i.e. allograft rejection. We therefore would like to present our combined medical and surgical treatment plan, which consists of an endoscopic fronto-spheno-ethmoidectomy as well as a meticulous daily nasal care program. The microbiological results show that our combined concept is effective, whereas especially daily nasal care with isotonic saline solution is the cornerstone in preventing significant colonisation of the sinuses and spreading bacteria to the lower respiratory tract causing lung allograft infection. Regarding the surgical part of our treatment, it should be emphasised that all sinuses and ethmoidal air cells should be widely opened. Edges such as bony overhangs should be smoothened to avoid mucus retention and consecutive bacterial recolonisation requiring subsequent revision surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Walter S, Gudowius P, Bosshammer J, Romling U, Weissbrodt H, Schurmann W, von der Hardt H, Tummler B (1997) Epidemiology of chronic Pseudomonas aeruginosa infections in the airways of lung transplant recipients with cystic fibrosis. Thorax 52(4):318–321

    Article  PubMed  CAS  Google Scholar 

  2. Mainz JG, Naehrlich L, Schien M, Käding M, Schiller I, Mayr S, Schneider G, Wiedemann B, Wiehlmann L, Cramer N, Pfister W, Kahl BC, Beck JF, Tümmler B (2009) Concordant genotype of upper and lower airways P. aeruginosa and S. aureus isolates in cystic fibrosis. Thorax 64(6):535–540

    Article  PubMed  CAS  Google Scholar 

  3. Roby BB, McNamara J, Finkelstein M, Sidman J (2008) Sinus surgery in cystic fibrosis patients: comparison of sinus and lower airway cultures. Int J Pediatr Otorhinolaryngol 72(9):1365–1369

    Article  PubMed  Google Scholar 

  4. Dosanjh A, Lakhani S, Elashoff D, Chin C, Hsu V, Hilman B (2000) A comparison of microbiologic flora of the sinuses and airway among cystic fibrosis patients with maxillary antrostomies. Pediatr Transpl 4(3):182–185

    Article  CAS  Google Scholar 

  5. Dosanjh AK, Elashoff D, Robbins RC (1998) The bronchoalveolar lavage fluid of cystic fibrosis lung transplant recipients demonstrates increased interleukin-8 and elastase and decreased IL-10. J Interferon Cytokine Res 18(10):851–854

    Article  PubMed  CAS  Google Scholar 

  6. Nunley D, Dauber J, Iacono A, Keenan R, Zeevi A, Cornwell R, Love R, Meyer K, Soergel P, Peterson K (1999) Unopposed neutrophil elastase in bronchoalveolar lavage from transplant recipients with cystic fibrosis. Am J Respir Crit Care Med 159(1):258–261

    PubMed  CAS  Google Scholar 

  7. Holzmann D, Speich R, Kaufmann T, Laube I, Russi EW, Simmen D, Weder W, Boehler A (2004) Effects of sinus surgery in patients with cystic fibrosis after lung transplantation: a 10-year experience. Transplantation 77(1):134–136

    Article  PubMed  Google Scholar 

  8. Leung MK, Rachakonda L, Weill D, Hwang PH (2008) Effects of sinus surgery on lung transplantation outcomes in cystic fibrosis. Am J Rhinol 22(2):192–196

    Article  PubMed  Google Scholar 

  9. Osborn AJ, Leung R, Ratjen F, James AL (2011) Effect of endoscopic sinus surgery on pulmonary function and microbial pathogens in a pediatric population with cystic fibrosis. Arch Otolaryngol Head Neck Surg 137(6):542–547

    Article  PubMed  Google Scholar 

  10. Soyka MB, Holzmann D (2005) Correlation of complications during endoscopic sinus surgery with surgeon skill level and extent of surgery. Am J Rhinol 19(3):274–281

    PubMed  Google Scholar 

  11. Grobler A, Weitzel EK, Buele A, Jardeleza C, Cheong YC, Field J, Wormald PJ (2008) Pre- and postoperative sinus penetration of nasal irrigation. Laryngoscope 118(11):2078–2081

    Article  PubMed  Google Scholar 

  12. Soler ZM, Hwang PH, Mace J, Smith TL (2010) Outcomes after middle turbinate resection: revisiting a controversial topic. Laryngoscope 120(4):832–837

    Article  PubMed  Google Scholar 

  13. Desrosiers MY, Kilty SJ (2008) Treatment alternatives for chronic rhinosinusitis persisting after ESS: what to do when antibiotics, steroids and surgery fail. Rhinology 46(1):3–14

    PubMed  Google Scholar 

  14. Harvey R, Hannan SA, Badia L, Scadding G (2007) Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev 18(3):CD006394

    Google Scholar 

Download references

Acknowledgments

We would like to express our gratitude to Dr. Thomas Pézier, MD, for his helpful editorial work and the proof-reading of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Frauenklinikstrasse 24, 8091, Zurich, Switzerland

    Domenic Vital & David Holzmann

  2. Division of Pulmonary Medicine, University Hospital, Zurich, Switzerland

    Markus Hofer & Annette Boehler

Authors
  1. Domenic Vital
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Markus Hofer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Annette Boehler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Holzmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Domenic Vital.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vital, D., Hofer, M., Boehler, A. et al. Posttransplant sinus surgery in lung transplant recipients with cystic fibrosis: a single institutional experience. Eur Arch Otorhinolaryngol 270, 135–139 (2013). https://doi.org/10.1007/s00405-012-2002-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-012-2002-y

Keywords

Search

Navigation