ACUTE AND CHRONIC SINUSITIS - A CAUSE OF UNSUSPECTED PATHOLOGY IN PATIENTS WITH END-STAGE LIVER-DISEASE

Objective: To determine the prevalence of acute sinusitis by physical examination and radiology in individuals presenting for liver transpla ntation. Design: One hundred consecutive individuals presenting for a liver transplant were studied prospectively for evidence of acute sinu sitis. Forty-eight spouses, relatives or partners accompanying the pat ient to the transplant center agreed to act as controls. Setting: Tert iary referral hospital. Methods: A complete physical examination was p erformed with particular attention to the eyes, ears, nose and naso-or opharynx. A series of sinus radiographs were also taken consisting of anterior, posterior, lateral, Caldwell and Waters views of the nasal s inuses; air fluid levels within the sinuses were assessed. Results: Th irty-eight per cent of the patients, but only 8.5% of the controls, ha d radiologic evidence of sinus pathology (P < 0.01). The maxillary sin uses were predominantly involved and mucosal thickening was the most f requent radiologic evidence of sinusitis. Conclusions: These data sugg est that sinus pathology occurs at an increased rate in individuals wi th advanced liver disease and that the pathology is characterized by m ucosal thickening in association with an air fluid level.