Study of ethmoid sinus involvement in multibacillary leprosy

Abstract

The nasal mucosal involvement in lepromatous leprosy is well recognized. Currently interest has centred around the involvement of paranasal sinuses in leprosy. They act as a reservoir and constant source of reinfection to the nasal mucosa. In the present prospective study 25 untreated patients with multi-bacillary leprosy were included. Clinical examination, computed tomography (CT) scan of paranasal sinuses, ethmoid sinus endoscopy and biopsy were carried out in all patients, to investigate the involvement of the paranasal sinuses in leprosy.Ethmoid sinus involvement was noted in 20 patients on CT scan. Bilateral involvement was more common (65 per cent). Anterior ethmoids were more commonly affected (65 per cent). On ethmoid sinus endoscopy abnormal mucosa was noted in 17 patients (68 per cent). Ethmoid sinus biopsy was confirmative in 16 patients (64 per cent). Statistically significant correlation was found between CT findings, sinus endoscopy and sinus biopsy findings.

Olfactory Dysfunction in Leprosy

“…Other factors may also become involved at later stages of infection. Thus, the influence of M. leprae on the upper respiratory tract often manifests itself as swelling, ulceration, perforation, or the collapse of septal cartilage and paranasal sinuses 14 . Peripheral nerve infiltration, motor and sensory abnormalities, autonomic nerve dysfunction, and ganglia infiltration have been reported in leprosy patients 15,16 .…”

Chronic rhinosinusitis in ex-lepromatous leprosy patients with atrophic rhinitis

“…2,7,8 On the other hand, a previous study of treated lepromatous leprosy patients found septal perforation in 47.3 per cent (18 of 38), suggesting that, in cases of persistent infection, cartilage destruction may continue even after the treatment of leprosy. Lepromatous leprosy is the severest type of leprosy, so we presumed that massive chronic granulomatous infection had caused these scar formations.…”

“…7,8 Similarly, the ethmoidal sinuses have been reported to be the most commonly involved sinuses (55.2 per cent) in treated lepromatous leprosy patients; furthermore, 33.3 per cent of these patients have had persistent acidfast bacilli infection. Ex-leprosy patients are sometimes exposed to antibiotics for management of the complications of leprosy.…”

“…6 Leprosy also causes after-effects such as atrophic rhinitis and saddle nose deformity, complications which can permanently reduce patients' quality of life. 7 Chronic granulomatous infection finally causes septal perforation, saddle nose deformity and secondary atrophic rhinitis. The paranasal sinus can also be affected and then act as a reservoir of the bacilli.…”

Olfactory Dysfunction and Olfactory Bulb Volume Reduction in Patients with Leprosy

“…Other changes affecting olfactory function occur in later stages of the disease. M. lepra causes edema, swelling, ulceration, septic perforation, and collapse at the upper respiratory tract [23]. Peripheral neuron infiltration, motor and sensorial abnormalities, autonomic nerve dysfunction, and ganglion infiltration have been reported in people who have leprosy [24].…”