Clinical features of sarcoid rhinosinusitis

We asked if certain clinical features were useful predictors of sarcoid rhinosinusitis in general populations of patients with chronic rhinosinusitis.

Our patients with sarcoid rhinosinusitis and those from the literature formed the study group. A group of 21 randomly selected patients from The University of Mississippi Medical Center Allergy Clinic with chronic rhinosinusitis composed the control group.

Our literature search identified 73 patients with sarcoid rhinosinusitis reported since 1999. Twenty patients met inclusion criteria and were added to 16 of our patients to compose the study group of 36 patients. The majority of the study group was African-American (61%) and female (69%) and had pulmonary sarcoidosis (67%) and other forms of extrapulmonary sarcoidosis in addition to sarcoid rhinosinusitis (86%). The 5 most common upper respiratory signs/symptoms were nasal obstruction (86%), nasal crusting (47%), anosmia (44%), epistaxis (28%), and nasal polyposis (25%). Odds ratios for sarcoid rhinosinusitis were 2.5 for persistent nasal obstruction, 7.7 for epistaxis, 16.0 for anosmia, and 18.8 for nasal crusting. For each symptom, the odds of sarcoid rhinosinusitis increased by 9.4 (95% confidence interval, 1.8-49.9). Nasal crusting was associated with the coexistence of atrophic rhinosinusitis at nasal endoscopy. Treatment with oral corticosteroids and other immunosuppressive therapy, primarily methotrexate, was frequently required.

The coexistence of chronic rhinosinusitis and 2 of the signs of nasal crusting, anosmia, or epistaxis are highly specific for sarcoid rhinosinusitis. Even in the absence of an established diagnosis of sarcoidosis, sinonasal biopsy should be considered for diagnosing these patients with chronic rhinosinusitis.