Sinonasal Manifestations of Sarcoidosis: A Single Institution Experience with 38 Casess

Journal Article
aloulah, Mohammad . 2013
Publication Work Type
بحث علمي طبي
Magazine \ Newspaper
American journal of allergy and immunology
Publication Abstract

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


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.