title: Sinonasal manifestations of sarcoidosis: a single institution experience with 38 cases.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Retrospective analysis was performed of patients evaluated at a tertiary care referral center between January 2006 and July 2011.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
authors: Mohammad
authors: M
authors: Aloulah
authors: R Peter
authors: RP
authors: Manes
authors: Yuk Hui
authors: YH
authors: Ng
authors: John E
authors: JE
authors: Fitzgerald
authors: Craig S
authors: CS
authors: Glazer
authors: Matthew W
authors: MW
authors: Ryan
authors: Bradley F
authors: BF
authors: Marple
authors: Pete S
authors: PS
authors: Batra
mesh_terms: D000328:Adult; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009668:Nose Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D012507:Sarcoidosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed
keywords: chronic sinusitis; endoscopy; granulomatous disease; sarcoidosis; sinonasal; sinus surgery