Laryngeal Sarcoidosis

Abstract

Sarcoidosis is a chronic granulomatous disease that tends to involve the lungs, hilar and mediastinal lymph nodes, liver, eyes, skin, bones, and nervous system. Sarcoidosis involves the larynx less commonly than it afflicts these other sites. Laryngeal sarcoidosis may occur in isolation or as a component of systemic sarcoidosis and it may produce hoarseness, dysphagia, and dyspnea. Life-threatening airway obstruction can occur. Treatments used for laryngeal sarcoidosis have included tracheotomy, low-dose radiation, surgical excision, systemic steroids, and intralesional steroids. An autoimmune etiology has been suggested. The patient reported in this manuscript showed marked, sustained improvement following the use of inhaled steroids prescribed for obstructive pulmonary disease. The possible efficacy of steroid inhalers for treatment of laryngeal sarcoidosis warrants further investigation.

Sarcoidosis and its otolaryngological implications

“…Isolated laryngeal sarcoidosis without systemic disease is an even more rare presentation. In the large series of laryngeal sarcoidosis, the distribution of the most common symptoms were as follows: hoarseness (70-85%), dysphonia (10-40%), dyspnoea (47-60%) or stridor (8-10%), dysphagia (60-85%), globus pharyngeus (8-10%), cough (10-13%) and no laryngeal symptoms (8-18%) [27][28][29][30]. The clinical Wndings in patients with laryngeal sarcoidosis are usually non-speciWc, and the laryngeal mucosa appears oedematous, pale and prominent.…”

“…The involvement of the true vocal fold is rare (about 1%). The frequency of this localisation is conWrmed by a majority of studies on laryngeal sarcoidosis and case reports [27][28][29][30][31][32][33]. A diVerence in localisation was seen in the series of six African-American patients with laryngeal sarcoidosis, in which only two patients had limited supraglottic involvement and avoided tracheotomy, whilst four had extensive sarcoid granulomas involving two or three sections of the larynx and required surgical management due to upper airway obstruction [34].…”

“…The diVerential diagnosis of laryngeal sarcoidosis includes epiglottitis, granulomatous laryngitis of another cause, including tuberculosis, histoplasmosis, blastomycosis, coccidioidomycosis, syphilis and actinomycosis, malignant neoplasm, cartilaginous tumours and rare diseases of the larynx such as Wegener's granulomatosis and amyloidosis [27][28][29][30][31][32][33][34][35][36][37].…”

“…Low-dose external beam radiation therapy is an alternative treatment modality in adults in whom intralesional steroids or local granuloma excisions are not feasible and in those who are refractory to systemic steroids [27][28][29][30][31][32][33][34][35][36][37].…”

Evaluation of the patient with hoarseness

“…It most commonly involves the epiglottis followed by the arytenoids, aryepiglottic folds and false vocal cords. Edematous, pale and diffuse enlargement of the supraglottic structures is the most common laryngeal manifestation [24,25].…”