Head and Neck Manifestations in Sarcoidosis: An All of Us Research Program Matched Case-Control Study

This study aims to assess the prevalence of head and neck (ENT) symptoms in patients with sarcoidosis.

1:4 matched-case control study.

Patients with and without sarcoidosis who enrolled in the All of Us Research Program and consented to electronic medical record use.

Multivariate logistic regression examined the association between ENT symptoms and sarcoidosis, adjusting for autoimmune status, the Charlson Comorbidity Index score, and smoking status.

A total of 2446 patients with sarcoidosis were matched to 9783 controls. Compared to age-, sex-, race-, and ethnicity-matched controls and after adjustment, patients with sarcoidosis are more likely to have a recorded diagnosis of sinonasal symptoms, including chronic rhinitis (adjusted OR: 2.061 (95% CI: 1.779-2.387), P < .001), chronic sinusitis (aOR: 1.735 (1.533-1.964), P < .0001), and epistaxis (aOR: 1.479 (1.214-1.801), P < .0001). Patients with sarcoidosis were more likely to have a recorded diagnosis of swallowing and airway symptoms, including dysphonia (aOR: 1.459 (1.215-1.753), P < .0001) and dysphagia (aOR: 1.488 (1.312-1.688), P < .0001). They were also more likely to have a recorded diagnosis of cranial nerve pathologies (aOR: 1.783 (1.525-2.084), P < .0001) but less likely salivary gland pathologies (aOR: 0.600 (0.436-0.827), P = .0018). Controls were more likely to have a recorded diagnosis of impacted cerumen (aOR: 0.505 (0.405-0.630), P < .001).

Patients with sarcoidosis are significantly more likely to be diagnosed with sinonasal symptoms, airway and swallowing symptoms, and cranial nerve pathologies with prevalence rates higher than previously reported. Sarcoidosis of the upper airway is likely underdiagnosed and consequently undertreated, necessitating greater awareness and further exploration of the etiology of upper airway symptoms in patients with sarcoidosis.