Clinical Characteristics, Diagnostic Features, and Medical Treatment of Sinonasal Sarcoidosis: A Systematic Review

BackgroundSinonasal sarcoidosis (SNS) is an under-recognized manifestation of a multisystem granulomatous disease that often mimics common nasal inflammatory conditions, leading to diagnostic delays and uncertainty regarding optimal long-term management.ObjectiveThe purpose of this study was to review the clinical presentation, diagnosis, and medical management of SNS.MethodsA systematic review was conducted using CINAHL, Cochrane Library, PubMed, and Scopus through August 2025. Eligible studies included case reports, case series, and observational studies. Extracted variables included demographics, symptoms, diagnostic findings, treatments, and outcomes. Data was summarized as means, proportions, and 95% confidence intervals (CIs). Risk of bias was assessed with the Joanna Briggs Institute tool.ResultsSixty-eight studies (n = 369) were included. Mean age was 39.6 years (95% CI: 37.7-41.5), and 66.5% were female. The average interval from symptom onset to diagnosis was 61.7 months (95% CI: 35.8-87.6). Common presenting symptoms included nasal obstruction (39.3%), rhinorrhea (29.1%), and crusting (26.4%). Extra-nasal manifestations were frequent, particularly cutaneous involvement (39.1%) and peripheral lymphadenopathy (29.7%). Abnormal nasal endoscopy commonly demonstrated nasal crusting (38.2%) and mucosal inflammation (38.1%). Histological confirmation was most often obtained via sinonasal mucosal biopsy (75.4%). Systemic corticosteroids were the predominant first-line therapy, with 77.0% of patients demonstrating clinical improvement, though prolonged treatment courses and relapses were common.ConclusionThere is typically a prolonged delay between the onset of symptoms and the diagnosis of SNS. Understanding the common presenting symptoms, endoscopic features, and laboratory findings may facilitate proper diagnosis and treatment.