Sarcoidosis of the ear, nose and throat: A review of the literature

Abstract

Objectives Sarcoidosis is a multisystemic inflammatory disease with extrathoracic manifestations, most commonly affecting the young and middle‐aged, female and Black populations. Diagnosis usually requires evidence of non‐caseating granulomata and, when treated, prognosis is usually favourable. We aim to establish the incidence, clinical features and optimal treatment of ENT manifestations of this disease. Design We performed a PubMed literature review to determine the evidence base supporting this. Results ENT manifestations are present in 5%‐15% of patients with sarcoidosis, often as a presenting feature, and require vigilance for swift recognition and coordinated additional treatment specific to the organ. Laryngeal sarcoidosis presents with difficulty in breathing, dysphonia and cough, and may be treated by speech and language therapy (SLT) or intralesional injection, dilatation or tissue reduction. Nasal disease presents with crusting, rhinitis, nasal obstruction and anosmia, usually without sinus involvement. It is treated by topical nasal or intralesional treatments but may also require endoscopic sinus surgery, laser treatment or even nasal reconstruction. Otological disease is uncommon but includes audiovestibular symptoms, both sensorineural and conductive hearing loss, and skin lesions. Conclusions The consequences of ENT manifestations of sarcoidosis can be uncomfortable, disabling and even life‐threatening. Effective management strategies require good diagnostic skills and use of specific therapies combined with established treatments such as corticosteroids. Comparisons of treatment outcomes are needed to establish best practice in this area.

Isolated laryngeal tuberculosis complex infection: expect the unexpected

“…The severity and extent of the condition determines the type of treatment, ranging from corticosteroids to immunosuppressants such as methotrexate, azathioprine or hydroxychloroquine. Sarcoidosis has a very low incidence of laryngeal involvement, around 0.6%, and usually affects the supraglottic region [ 6 ], presenting as diffuse thickening also called “turban-like” epiglottis. It can also manifest as small nodular lesions or localized infiltrative lesions [ 7 ].…”

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…Ocular and skin lesions are more common in young and middle‐aged adults 368 . Sinonasal involvement occurs in 1%–4% of cases and symptoms are non‐specific: chronic crusting (70%–90%), nasal obstruction (80%–90%), anosmia (70%), and epistaxis (2%) 355,357,369 . Aggressive non‐caseating granulomas can cause hard or soft palate erosions as well as a saddle‐nose deformity.…”

Autoimmune disease of head and neck, imaging, and clinical review

“…Involvement of extraocular muscles and orbital fat is uncommon but results in abnormal enhancement and enlargement of muscles and tendons and infiltrative heterogenous mass in retro orbital fat. 124,125 Optic nerve involvement may cause nonspecific findings such as high signal intensity on T2-weighted images of optic nerve and nodular enhancement and thickening on T1-weighted images. Differential diagnosis includes optic neuritis, lymphoma, and carcinomatosis.…”

“…Differentials are multinodular goiter and thyroid cancers. 125,126 Involvement of vessel of head and neck such as carotid is characterized by soft tissue thickening and enhancement around the vessel due to vasculitis. Nasal involvement appears similar to other idiopathic granulomatous diseases such as GPA and Churg-Strauss disease.…”