What is sinonasal sarcoidosis?

Although most physicians who think about sarcoidosis consider primarily the pulmonary manifestations of this disease, otolaryngologists are often confronted with patients who have findings in the head and neck region. As a multisystem disease, sarcoidosis can display a wide array of presentations in this anatomical region. Salivary gland sarcoidosis can produce inflammation and swelling of any of the major or minor salivary glands. Severe xerostomia can result from inflammation and ultimate replacement of the secretory components of these glands. Ocular involvement can present as conjunctivitis or uveitis, both often severe and difficult problems to manage. Facial nerve paralysis has also been associated with sarcoidosis, and the combination of uveitis, parotitis, and facial paralysis is a well-known syndrome often referred to as uveoparotid fever (Heerfordt's disease). The skin of the face can also display the typical lesions of lupus pernio or cutaneous sarcoidosis. Otologic sarcoidosis has also been described with problems ranging from otitis media to vestibular symptoms to neurosensory hearing loss.

Some of the most difficult to manage patients are those who present with symptoms in the nose and paranasal sinuses. The incidence of sinonasal sarcoidosis is not precisely known but appears to be reasonably low. Initial reports from the Mayo Clinic estimated that < 1% of patients with sarcoidosis ultimately display sinonasal involvement.[1] However, a recent prospective study done at our institution suggested that the incidence is at least 4%, and may actually be much higher.[2] The diagnosis of sinonasal sarcoidosis, although occasionally obvious, is usually difficult to make because differentiating typical chronic sinusitis from granulomatous inflammation associated with sarcoidosis can be challenging. Even in those cases where the diagnosis can be definitely established, effective treatment can be difficult. This paper will discuss the various presentations of sinonasal sarcoidosis and present various treatment strategies that can reduce and often eliminate the symptoms associated with sinonasal sarcoidosis.