Endoscopic airway management of laryngeal sarcoidosis.
OBJECTIVE
To report the results of treating laryngeal sarcoidosis with intralesional steroids and minimally invasive laser surgery. Sarcoidosis is a rare multisystem inflammatory disorder of unknown cause. Laryngeal involvement is extremely rare, and its optimal management remains controversial.


METHODS
Retrospective medical chart review. Settings Tertiary care center/national referral airway reconstruction center.


METHODS
Ten consecutive patients treated for laryngeal sarcoidosis between 2004 and 2008.


METHODS
Demographic and clinical information including extralaryngeal manifestations obtained from patient records, laryngeal anatomic subsite manifestation of disease, intraoperative findings, and scores from the Medical Research Council (MRC) dyspnea outcome assessment instrument (which was administered preoperatively, at the first postoperative outpatient visit 4-6 weeks later, and at last follow-up).


RESULTS
The patients included 9 women and 1 man, a total of 2.8% of the unit's adult surgical airway case mix (10 of 353). Mean (SD) age at presentation was 37 (17) years. All patients presented with dyspnea and dysphonia; 2 required emergency tracheostomy prior to treatment. Six patients presented with isolated laryngeal sarcoid. Supraglottis and arytenoids were affected in all patients. The median number of endoscopic treatments was 2 (range, 1-4). Significant improvement in MRC dyspnea grading was found postoperatively (P < .05), and patients with tracheostomy were successfully decannulated. The mean (SD) follow-up time was 24 (18) months. There were no adverse effects of surgery. Nine patients had a substantial dose reduction or discontinuation of their systemic corticosteroid therapy following endoscopic treatment.


CONCLUSIONS
Minimally invasive endoscopic surgery with intralesional corticosteroid injection and laser reduction is an effective method of controlling laryngeal sarcoid. It improves symptoms immediately with minimal morbidity and, most importantly, reduces the need for systemic steroid administration in most patients. This study supports early recognition and endoscopic intervention in the management of laryngeal sarcoidosis.
Department of Otolaryngology-Head and Neck Surgery, The National Centre for Airway Reconstruction, Charing Cross Hospital, London, England. colinbutler@doctors.org.uk
Colin R
CR
Butler
S A Reza
SA
Nouraei
Alasdair D
AD
Mace
Sherif
S
Khalil
Shona K
SK
Sandhu
Guri S
GS
Sandhu
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D003371:Cough / Q000209:etiology / Q000628:therapy; D055154:Dysphonia / Q000209:etiology / Q000628:therapy; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D007818:Laryngeal Diseases / Q000628:therapy*; D007828:Laryngoscopy; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D012135:Respiratory Sounds; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000628:therapy*; D012720:Severity of Illness Index; D014139:Tracheostomy
D000305:Adrenal Cortex Hormones; D008775:Methylprednisolone