Results
Between March 2014 and October 2018, 451 patients had BMT in our adult hematology clinic. 30 patients had an ORL consultation visit in our ORL clinic. Among these 30 patients, 14 (46,7%) of them were female, and 16 (53,3%) were male (female to male ratio of 0,87). The youngest patient was 24 years old, and the oldest patient was 72 years old. The mean age of transplantation was 46,55 years. Considering gender, the average age was 46,85 years in women and 49,5 years in men. There was not any statistically significant difference in age between female and male groups (p>0.05). The ORL consultation period between the transplant and the ORL examination was from the 8th day at the earliest to the 333rd day at the latest. The average time between transplant and ORL review is 72.73. was the day. Considering the gender, the average ORL consultation time between transplantation and ORL examination was 101.42 days in women and 47.62 days in men. The mean time between transplant and ORL review was significantly higher in the female group (p = 0.001). When we looked at patients according to anatomical sites, 17 (56,7%) patients had ear problems; 8 (26,7%) patents had sinonasal problems and 5 (16,6%) patients had oropharyngeal problems. All these distributions are shown in table 1.
Table 1: Patient Distribution by ORL Consultation Time, Gender and Anatomical Regions
Three (10%) of these 30 patients had TBR prior to BMT, and the remaining 27 (90%) received chemotherapy for bone marrow suppression.
Hearing loss was the most common ear manifestation in BMT after transplantation. It was seen in 13 (76,48%) patients. Among these patients 10 had only hearing loss, one of these had hearing loss with tinnitus, one of these had hearing loss with vertigo and one of these hearing losses with external ear canal edema. In these hearing losses, 8 (61,54%) of them were neurosensorial type hearing loss and 5 (38,46%) of them were conductive type hearing loss. 6 (46,15%) patients of them were treated with medical ways (Ear drops or oral medication), 7 (53,85 %) of them referred for hearing aid devices. Among all ear manifested patients 2 (11,76%) of them had ear discharge and treated by ear drops; and last 2 (11,76%) of them had obstruction of outer ear canal by ear wax and they treated by cleaning of ear wax. This distribution is shown in table 2.
Table 2: Ear Findings of Patients with BMT After Transplant
Sinonasal problems were the second most common ORL consultation reason for BMT patients. Eight (26,7%) patients were sent to ORL clinic for consultation because of sinonasal problems. Among these 7 (87,5%) of them applied for epistaxis which was not controlled by transplantation team. Three (42,8%) of them had bleeding come from right nasal cavity, 2 (28,6%) of them had bleeding from left nasal cavity and 2 (28,6%) of them had bleeding from both nasal cavities. 5 (71,4%) of these patients were treated by silver nitrate cauterization. Two (28,6%) of them were treated by other nonsurgical treatment methods such as topical decongestants and nose moisturizer agents. None of these patients needed surgical epistaxis treatment methods. One (12,5%) patient consulted for cough problem which diagnosed as sinusitis and treated with antibiotics and nasal saline wash. This distribution is shown in table 3.
Table 3: Sinonasal Findings of Patients with BMT After Transplant
In 30 ORL consulted patients, 5 (16,6%) of them consulted for orphanageal problems. Among them 3 (60%) patients had widespread severe mucosal lesions and submucosal bleedings. They were diagnosed as severe mucositis and treated by medical measures. One (20%) patient had acute pharyngitis and treated with antibiotics. One (20%) patient had abscess formation within mouth and treated by surgical drainage. This distribution is shown in table 4.
Table 4: Oropharyngeal Findings of Patients with BMT After Transplant