Baylor University Medical Center Proceedings October 2017 - 454

a

b

nasal irrigation is recommended in
all patients with sinonasal disease to
eliminate nasal crusting.

1. Plaschke CC, Owen HH, Rasmussen
N. Clinically isolated laryngeal sarcoidosis. Eur Arch Otorhinolaryngol
2011;268(4):575-580.
2. Milburn HJ, Poulter LW, Dilmec A,
Cochrane GM, Kemeny DM. Corticosteroids restore the balance between
locally produced Th1 and Th2 cytokines
and immunoglobulin isotypes to normal in sarcoid lung. Clin Exp Immunol
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Figure 4. A bronchoscopic examination showing (a) erythema and edema of the supraglottis, including the arytenoids
3. Benjamin B, Dalton C, Croxson G.
and false vocal cords or vestibular folds, and (b) a subglottic nodular lesion in the trachea.
Laryngoscopic diagnosis of laryngeal
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treatment (8, 12). Spontaneous remission occurs only in about
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10% of cases of laryngeal sarcoidosis (13). The role of corticoAnn Otol Rhinol Laryngol 1982;91(4 Pt 1):359-362.
steroids in the clinical management of sarcoidosis is well estab5. Zeitlin JF, Tami TA, Baughman R, Winget D. Nasal and sinus manifestalished through its effects on lymphocyte-macrophage function.
tions of sarcoidosis. Am J Rhinol 2000;14(3):157-161.
6. Rossman MD, Thompson B, Frederick M, Maliarik M, Iannuzzi MC,
The lack of a response after 3 months of corticosteroid treatment
Rybicki BA, Pandey JP, Newman LS, Magira E, Beznik-Cizman B, Monos D;
suggests irreversible fibrotic disease, nonadherence to therapy,
ACCESS Group. HLA-DRB1*1101: a significant risk factor for sarcoidosis
or an inadequate dose of prednisone. Inhaled corticosteroid
in blacks and whites. Am J Hum Genet 2003;73(4):720-735.
therapy provides simple and safe drug delivery to sites of in7. Braun JJ, Gentine A, Pauli G. Sinonasal sarcoidosis: review and report of
flammation. Some studies have demonstrated that nasal steroids
fifteen cases. Laryngoscope 2004;114(11):1960-1963.
have a benefit similar to oral steroids in sinonasal sarcoidosis
8. Duchemann B, Lavolé A, Naccache JM, Nunes H, Benzakin S, Lefevre M,
Kambouchner M, Périé S, Valeyre D, Cadranel J. Laryngeal sarcoidosis: a
(14). However, data are limited on the effectiveness of inhaled
case-control study. Sarcoidosis Vasc Diffuse Lung Dis 2014;31(3):227-234.
corticosteroids in laryngeal sarcoidosis (15). Current treatment
9. McLaughlin RB, Spiegel JR, Selber J, Gotsdiner DB, Sataloff RT.
regimens often include hydroxychloroquine and methotrexLaryngeal sarcoidosis presenting as an isolated submucosal vocal fold
ate or azathioprine in cases with glucocorticoid resistance or
mass. J Voice 1999;13(2):240-245.
severe side effects. Hassid et al reported a good response to
10. Mastan S, Advani R, Stobbs N, Kumar N. A rare manifestation of a
multisystemic disease: a case of vocal cord palsy secondary to sarcoidosis.
hydroxychloroquine in a patient with extensive sarcoidosis of
BMJ Case Rep 2015;2015:bcr2015209728.
the paranasal sinuses (16).
11. Sada M, Saraya T, Ishii H, Goto H. Sudden multiple fractures in a patient with
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sarcoidosis in multiple organs. BMJ Case Rep 2014;2014:bcr2013201408.
with high levels of spontaneously released tumor necrosis
12. Culver DA. Sarcoidosis of the upper and lower airways. In Mehta AC,
factor-alpha (TNF-α) in bronchoalveolar lavage had a signifiJain P, Gildea TR (eds.), Diseases of the Central Airways. New York:
Humana Press, 2016:71-85.
cantly greater risk of disease progression and corticosteroid re13.
Tsubouchi
K, Hamada N, Ijichi K, Umezaki T, Takayama K, Nakanishi Y.
sistance than those with a normal TNF-α level (43.8% vs 8.3%,
Spontaneous improvement of laryngeal sarcoidosis resistant to systemic
respectively) (17). Randomized controlled trials have shown
corticosteroid administration. Respirol Case Rep 2015;3(3):112-114.
favorable results with TNF-α antagonists for the treatment of
14. Sharma OP. Pulmonary sarcoidosis and corticosteroids. Am Rev Respir Dis
chronic active sarcoidosis (18). Judson and Baughman studied
1993;147(6 Pt 1):1598-1600.
15. Alberts C, van der Mark TW, Jansen HM; Dutch Study Group on
the effectiveness of infliximab therapy in chronic sarcoidosis.
Pulmonary Sarcoidosis. Inhaled budesonide in pulmonary sarcoidosis: a
No cases of laryngeal sarcoidosis were included in the study, but
double-blind, placebo-controlled study. Eur Respir J 1995;8(5):682-688.
a few cases of nasal sarcoidosis were included. At 24 weeks, the
16. Hassid S, Choufani G, Saussez S, Dubois M, Salmon I, Soupart A.
total score of extrapulmonary sarcoidosis severity was decreased
Sarcoidosis of the paranasal sinuses treated with hydroxychloroquine.
by >40% in the infliximab group compared to the placebo
Postgrad Med J 1998;74(869):172-174.
17. Baughman RP, Lower EE, Tami T. Upper airway. 4: Sarcoidosis of the
group (19). Clinicians should consider alternative therapies,
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such as anti-TNF-α inhibitors, early in the course when the
18. Baughman RP, Drent M, Kavuru M, Judson MA, Costabel U, du
response to usual therapy is poor.
Bois R, Albera C, Brutsche M, Davis G, Donohue JF, Müller-Quernheim J,
Minimally invasive endoscopic surgery with intralesional
Schlenker-Herceg R, Flavin S, Lo KH, Oemar B, Barnathan ES; Sarcoidosis
corticosteroid injection improves symptoms with minimal morInvestigators. Infliximab therapy in patients with chronic sarcoidosis and
bidity and reduces the need for systemic corticosteroids in most
pulmonary involvement. Am J Respir Crit Care Med 2006;174(7):795-802.
19. Judson MA, Baughman RP, Costabel U, Flavin S, Lo KH, Kavuru MS,
patients. Surgical excision using cold instruments, CO2 lasers, or
Drent M; Centocor T48 Sarcoidosis Investigators. Efficacy of infliximab
microdebriders has been reported with good results (20). In sinoin extrapulmonary sarcoidosis: results from a randomised trial. Eur Respir
nasal sarcoidosis, minimally invasive surgeries, including endoJ 2008;31(6):1189-1196.
scopic sinus surgery, can significantly improve the quality of life,
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