Sinonasal Manifestations of Sarcoidosis: A Single Institution Experience with 38 Casess
aloulah, Mohammad . 2013
Sinonasal Manifestations of Sarcoidosis
A Single Institution Experience with 38 Cases
Mohammad Aloulah, MD.
Department of Otolaryngology – Head and Neck Surgery
King Abdulaziz University Hospital, King Saud University, Riyadh, KSA
Abstract:
Introduction: 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 764 patients evaluated at a tertiary care referral center between January 2006 and July 2011.
Results: Sinonasal involvement was evident in 38 cases (5.0%). The mean age was 52 years with 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%). 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 symptom improvement was noted in 39.5% at mean follow-up of 16.2 months.
Conclusion: Sinonasal involvement was noted in approximately 5% of patients with known sarcoidosis. 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.
The endoscopic modified Lothrop procedure reduces systemic steroid requirements in chronic rhinosinusitis with nasal polyposis.
Sinonasal Manifestations of Sarcoidosis
A Single Institution Experience with 38 Cases
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