Laryngeal Sarcoidosis with Airway Obstruction

Abstract

Sarcoidosis is a chronic systemic granulomatous disease that occasionally affects the larynx. When the degree of involvement is marked, significant airway obstruction can occur. We present four cases of laryngeal sarcoidosis that resulted in airway obstruction. The clinical features of sarcoidosis of the larynx are discussed, and current methods of treatment are summarized. The laryngologist should include laryngeal sarcoidosis in the differential diagnosis of patients with airway obstruction, and should play a major role in its management.

Sarcoidosis

“…Similar evidence of tracheal narrowing in a patient with laryngeal sarcoidosis was noted by Vico and Larsen (1979) at a rather higher level. In Case 2 of Weisman et al (1980) there were subglottic masses, and at bronchoscopy a similar mass was seen at the carina. Spencer and Warren (1938) reported the necropsy findings in a case of sarcoidosis involving many organs, including the heart, in which the treachea contained many irregularly arranged submucosal foci with fibrosis causing local distortion; there was no note whether the larynx was involved.…”

“…McKelvie et al., 1968, Case 10;Vico and Larsen, 1979;Weisman et al, 1980, Case 2); and persistently active sarcoidosis of the larynx or fibrotic narrowing and distortion that may persist after the active stage in severe cases may necessitate permanent tracheostomy (Rosedale, 1945;Poe and Seager, 1950;Di Benedetto and Lefrak, 1970). Local removal of obstructing tissue, either endosopically or by laryngotomy may be helpful (Poe and Seager, 1950;Devine, 1965, Cases 2 and 6;McKeivie et al, 1968, Case 10).…”

Polypoid type of laryngeal sarcoidosis - case report and review of the literature

“…Thus, in cases that do not resolve spontaneously, treatment for laryngeal sarcoidosis should be performed to remove obstruction in the airway. Sarcoidosis of the larynx occasionally does not respond well to systemic corticosteroids [15]. Krespi et al [10] reported that in all their six cases, obstructions in the airway declined after steroids were injected into supraglottic lesions at the time of direct laryngoscopy.…”

Pathology Quiz Case

“…Unlike the pulmonary and hilar manifestations of sarcoidosis, laryngeal lesions often require treatment with both systemic steroids and local injections to prevent airway obstruction and thus to obviate the need for a tracheostomy. [5][6][7][8] The incidence of laryngeal sarcoidosis in the setting of systemic disease ranges from 1.4% to 5.0% of all cases. 8 However, laryngeal involvement may present as an isolated and sole manifestation of sarcoidosis.…”

“…[5][6][7][8] The incidence of laryngeal sarcoidosis in the setting of systemic disease ranges from 1.4% to 5.0% of all cases. 8 However, laryngeal involvement may present as an isolated and sole manifestation of sarcoidosis. 2,9 The isolated type of laryngeal sarcoidosis reported may represent the larynx as the only site identified in the setting of clinically recognized systemic disease.…”