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 transplantation. Design: One hundred consecutive individuals presenting for a liver transplant were studied prospectively for evidence of acute sinusitis. Forty-eight spouses, relatives or partners accompanying the patient to the transplant center agreed to act as controls. Setting: Tertiary referral hospital. Methods: A complete physical examination was performed with particular attention to the eyes, ears, nose and naso-oropharynx. A series of sinus radiographs were also taken consisting of anterior, posterior, lateral, Caldwell and Waters views of the nasal sinuses; air fluid levels within the sinuses were assessed. Results: Thirty-eight per cent of the patients, but only 8.5% of the controls, had radiologic evidence of sinus pathology (P < 0.01). The maxillary sinuses were predominantly involved and mucosal thickening was the most frequent radiologic evidence of sinusitis. Conclusions: These data suggest that sinus pathology occurs at an increased rate in individuals with advanced liver disease and that the pathology is characterized by mucosal thickening in association with an air fluid level.