EFFECT OF NASOGASTRIC TUBES ON THE NOSE AND MAXILLARY SINUS

Objective: To estimate the proportion of patients who develop radiologic evidence of maxillary sinus inflammation among those who are maintained on nasogastric (NG) tubes after major surgery. Design: Prospective case series. Setting: Patients were drawn from the general surgical and ear, nose, and throat units of a tertiary care hospital. Method: All patients undergoing major surgery with or without a concurrent tracheostomy, in whom an NG tube was retained for greater-than-or-equal-to 48 hrs, were examined clinically and radiologically for evidence of maxillary sinus inflammation. Results: Sixty-five patients were studied. Twenty patients had a concurrent tracheostomy and 45 patients were without tracheostomy. Only 10% of the patients in the tracheostomy group developed radiologic evidence of sinus inflammation, as compared with 50% in the nontracheostomy group (p < .05). The proportion of patients who developed clinical evidence of rhinitis was about 75% in either group. However, none of the patients in the study had clinical evidence of maxillary sinusitis. There was no correlation between the age of the patient, sex, use of broad-spectrum antibiotics, or duration of NG intubation with the onset of sinus inflammation. Conclusions: The presence of NG tubes predisposes to nasal and maxillary sinus inflammation. Sinonasal symptoms of clinical sinusitis may not be present even when radiologic evidence of inflammation is evident. In patients with tracheostomy, the frequency of maxillary sinus inflammation is significantly lower than in those patients without tracheostomy.