Sinonasal manifestations of sarcoidosis: a single institution experience with 38 cases
Potential conflict of interest: Conflict of interest: MWR: Teva (consultant), Sunovion (consultant); CSG: Intermune, Fibrogen, Boehringer-Ingelheim, NIH (research grants); BFM: Teva (consultant), Sunovion (consultant); PSB: Medtronic (research grant), Medtronic (consultant). MA, RPM, YHN, and JEF: None provided.
Correspondence to: Pete S. Batra, MD, FACS, Comprehensive Skull Base Program, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390; e-mail: email@example.com
Sarcoidosis is a chronic disease process characterized by non-caseating granulomatous inflammation, usually involving the lower respiratory tract. Given the rarity of rhinologic involvement, the objectives of the present study were (1) to describe clinical features, and (2) to review outcomes of rhinologic surgery for sinonasal sarcoidosis.
Retrospective analysis was performed of patients evaluated at a tertiary care referral center between January 2006 and July 2011.
The mean age of the 38 patients with sinonasal sarcoidosis was 52 years, with a female:male ratio of 2.8:1. The most common presenting symptoms included nasal obstruction (65.8%), crusting (29.9%), and epistaxis (18.4%). Most frequent endoscopic findings included crusting (55.3%), mucosal thickening (44.7%), and subcutaneous nodules (21%). Computed tomography (CT) imaging demonstrated turbinate or septal nodularity (21%), osteoneogenesis (15.8%), and bone erosion (10.5%). Medical management was typically comprised of saline irrigations (73.3%), topical nasal steroids (68.4%), and oral steroids (63.2%). Refractory sinus symptoms required sinonasal surgery in 4 cases. Overall subjective symptom improvement was noted in 39.5% at mean follow-up of 16.2 months.
Sinonasal involvement was noted in approximately 30% of patients with known sarcoidosis evaluated in the otolaryngology clinic. Patients typically present with nasal obstruction and endoscopic evidence of crusting and mucosal thickening. Medical therapy with irrigations and topical/oral steroids suffices in majority of patients, with surgery for refractory symptoms being required in a small subset of cases.