Chronic rhinosinusitis in ex-lepromatous leprosy patients with atrophic rhinitis.

AIM: Rhino-sinus mucosal involvement is well documented in untreated lepromatous leprosy, but less understood in ex-leprosy patients (i.e. leprosy patients who have been treated and cured) with atrophic rhinitis. MATERIALS AND METHODS: Rhino-sinus abnormalities were investigated in 13 ex-lepromatous leprosy patients with atrophic rhinitis, using interviews enquiring about sinonasal symptoms, nasal endoscopy, nasal swab culture and computed tomography. Endoscopic sinus surgery had been performed in three patients. The clinical course, computed tomography findings and nasal biopsy results of these three patients were evaluated. RESULTS: All patients had turbinate atrophy and 6 of the 13 (46.2 per cent) had septal perforation. Paranasal sinus involvement was noted in 9 of 12 examined patients (75 per cent). The most commonly affected sinus was the maxillary sinus (in 8 of 12; 66.7 per cent). All three patients treated by endoscopic sinus surgery experienced relapse and required further surgery. Maxillary sinus irrigation was effective for reduction of persistent symptoms such as postnasal discharge and crusts. CONCLUSION: Ex-lepromatous leprosy patients with atrophic rhinitis had various rhino-sinus abnormalities and persistent symptoms. These patients had chronic rhinosinusitis because of underlying atrophic rhinitis. These patients required repeated otolaryngological observations together with combined surgery and conservative treatment.

Radiological and antroscopic study of maxillary antrum in multibacillary leprosy patients.

Sixty consecutive patients having multibacillary leprosy were examined for symptoms of nasal involvement and sinusitis. A complete ENT examination was carried out of all these patients and they were subjected to radiological examination of paranasal sinuses. Radiological abnormalities of maxillary antrum were found in 15 of 20 cases of lepromatous leprosy, 6 of 26 cases of borderline lepromatous and in 14 cases of mid-borderline leprosy. Localized or generalized mucosal thickening was the most common finding, followed by opacity of maxillary antrum. Radiological abnormalities were confirmed by antroscopy, which is the most appropriate technique for making an accurate diagnosis of maxillary antral diseases. Initially, antral involvement may begin with a localized area of mucol erythema, progressing to a typical granuloma formation and ulceration. The antero-inferior part of the antrum was found to be the most commonly affected region.