The clinical immunologist is playing an increasingly important role in the evaluation and management of sinus disease. Although most patients with sinus disease are not immunodeficient, a significant proportion of patients with chronic
sinusitis unresponsive to medical and/or surgical
therapy may have an immunodeficiency. Most immunodeficient patients for whom
sinusitis is a major clinical problem tend to be those with humoral immunodeficiency diseases. The role of
immunoglobulin replacement
therapy is well established for patients with global
immunoglobulin and antibody deficiencies (e.g.,
X-linked agammaglobulinemia and
common variable immunodeficiency) and may be helpful in controlling refractory
sinusitis in patients with more selective
immunoglobulin deficiencies (e.g.,
IgG subclass deficiency and selective antibody deficiencies), but efficacy in these conditions remains to be established by controlled studies. Many immunodeficient patients have a history of repeated sinus surgery before the recognition of their immune defect. Even in immunodeficient patients treated with
antibiotics and
immunoglobulin replacement
therapy, functional endoscopic sinus surgery is successful in only half of the patients.