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Farlow JL, Park JV, Morrison RJ, Kupfer RA. Office-Based Intralesional Steroid Injection for Treatment of Laryngeal Sarcoidosis. Ann Otol Rhinol Laryngol 2021; 130:976-979. [PMID: 33583192 DOI: 10.1177/0003489421995287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To report preliminary outcomes of a case series of in-office intralesional steroid injections for treatment of laryngeal sarcoidosis. METHODS After diagnosis of laryngeal sarcoidosis, 3 patients were offered in-office steroid injections for primary or adjunctive treatment. Triamcinolone 40 was injected into supraglottic sarcoidosis lesions in the office using a channel laryngoscope. Response to treatment and need for further injections was determined based on patient symptoms and repeat flexible laryngoscopy. RESULTS In-office intralesional steroid injections provided rapid symptom relief within days that lasted for months, thus decreasing the frequency of operative interventions. For one of the patients in this series, these injections even eliminated the need for tracheostomy. No complications were observed. CONCLUSIONS In-office intralesional steroid injection is an emerging adjunctive treatment for laryngeal sarcoidosis. Prospective studies are required to determine efficacy and long-term risk profiles in relation to the current standard of operative management and systemic treatments.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jiwon V Park
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Robert J Morrison
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Leedman SR, Hendriks T, Leahy TW, Hall D. Supraglottic laryngeal sarcoidosis masquerading as supraglottitis. BMJ Case Rep 2020; 13:13/1/e232369. [PMID: 31937627 DOI: 10.1136/bcr-2019-232369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is a rare multisystem disorder of unknown aetiology characterised by non-caseating granulomas in involved organs; it is a diagnosis of exclusion. Laryngeal involvement affects only 0.5%-5% of those with sarcoidosis. It is an uncommon but important cause of supraglottic inflammation and oedema and should be considered in the differential diagnosis in patients with supraglottitis. This case describes a 30-year-old man who presented with stridor and shortness of breath. Flexible nasendoscopic examination revealed a grossly oedematous, pale pink, diffusely hypertrophied epiglottis. Surgical biopsy revealed non-caseating granulomatous inflammation. In the context of exclusion of hepatitis, anti-neutrophil cytoplasmic antibody (ANCA) positivity, malignancy and mycobacterial infection, the diagnosis of supraglottic laryngeal sarcoid was made. He is being treated with azathioprine immunosuppression with symptomatic improvement.
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Affiliation(s)
- Samuel Robert Leedman
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - Thomas Hendriks
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - Travis William Leahy
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - David Hall
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
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Rafii B, Sridharan S, Taliercio S, Govil N, Paul B, Garabedian MJ, Amin MR, Branski RC. Glucocorticoids in laryngology: a review. Laryngoscope 2014; 124:1668-73. [PMID: 24474440 DOI: 10.1002/lary.24556] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 12/02/2013] [Accepted: 12/09/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS To provide the otolaryngologist an evidence-based sound review of glucocorticoid use for laryngeal pathology. STUDY DESIGN Review of contemporary peer-reviewed literature as well as review articles. METHODS A review of the literature regarding glucocorticoids as a therapeutic intervention for the treatment of benign laryngeal pathology and laryngeal manifestations of systemic disease was performed. Review included both systemic administration as well as local injection. RESULTS Glucocorticoids, administered in the critical care setting for planned extubation, markedly reducing the risk of reintubation and remain a rudimentary pharmacologic adjunct in laryngeal manifestations of common autoimmune and inflammatory disorders. Intralesional injection has reduced the rate of surgical intervention for benign inflammatory primary laryngeal pathology. CONCLUSIONS Glucocorticoids are effective in the treatment of a number of laryngeal pathologies, through both systemic and intralesional administration. However, a clear consensus for utilization of glucocorticoids in the treatment of specific laryngeal disorders has yet to be published.
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Affiliation(s)
- Benjamin Rafii
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York
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Morgenthau AS, Teirstein AS. Sarcoidosis of the upper and lower airways. Expert Rev Respir Med 2012; 5:823-33. [PMID: 22082167 DOI: 10.1586/ers.11.66] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease of undetermined etiology characterized by a variable clinical presentation and disease course. Although clinical granulomatous inflammation may occur within any organ system, more than 90% of sarcoidosis patients have lung disease. Sarcoidosis is considered an interstitial lung disease that is frequently characterized by restrictive physiologic dysfunction on pulmonary function tests. However, sarcoidosis also involves the airways (large and small), causing obstructive airways disease. It is one of a few interstitial lung diseases that affects the entire length of the respiratory tract - from the nose to the terminal bronchioles - and causes a broad spectrum of airways dysfunction. This article examines airway dysfunction in sarcoidosis. The anatomical structure of the airways is the organizational framework for our discussion. We discuss sarcoidosis involving the nose, sinuses, nasal passages, larynx, trachea, bronchi and small airways. Common complications of airways disease, such as, atelectasis, fibrosis, bullous leions, bronchiectasis, cavitary lesions and mycetomas, are also reviewed.
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Affiliation(s)
- Adam S Morgenthau
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 1 Gustave L. Levy Place, Box 12, New York, NY 10029, USA.
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Sarcoidosis and its otolaryngological implications. Eur Arch Otorhinolaryngol 2010; 267:1507-14. [PMID: 20617327 DOI: 10.1007/s00405-010-1331-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 06/28/2010] [Indexed: 12/15/2022]
Abstract
Sarcoidosis and its aetiopathogenesis, epidemiology and diagnostic procedures (including the Kveim reaction) are presented in this paper. The clinical manifestations of this disease, especially in otolaryngological organs, including the larynx, salivary glands, nose and paranasal sinuses, are described. Treatment procedures, including surgical interventions and prognosis, are also discussed.
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Sims HS, Thakkar KH. Airway involvement and obstruction from granulomas in African–American patients with sarcoidosis. Respir Med 2007; 101:2279-83. [PMID: 17681462 DOI: 10.1016/j.rmed.2007.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 06/05/2007] [Accepted: 06/25/2007] [Indexed: 10/23/2022]
Abstract
Sarcoidosis is a global disorder whose breadth of organ involvement can often be underappreciated. Head and neck manifestations include involvement of the skin, salivary glands, sinonasal cavity, and larynx. Of cases of upper airway sarcoidosis, laryngeal sarcoidosis and airway compromise portend a greater risk of fatal outcomes. People representing all racial groups have been diagnosed with sarcoidosis. Although many studies have evaluated incidence and manifestations of sarcoidosis in multiple ethnicities, few studies have explored racial predilection for laryngeal involvement. However, assertions that disease severity and poor outcome may be tied to the African diaspora as well as related socio-economic and cultural realities have been recognized. We present our case series of six African-American patients diagnosed with sarcoidosis and presented with complaints of voice change and increased shortness of breath. Four of them required expeditious, surgical management of the airway. Two had limited supraglottic involvement and have avoided tracheotomy with aggressive and timely pharmacotherapeutic intervention and close clinical surveillance. Early recognition of laryngeal manifestations of sarcoidosis and airway compromise is essential to provide patients with conservative management without the need for aggressive surgical intervention.
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Affiliation(s)
- H Steven Sims
- Chicago Institute for Voice Care, University of Illinois at Chicago, 1855 W. Taylor Street, Room 2.42, Chicago, IL 60612, USA.
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Rupanagudi VA, Kanagarajan K, Jayawardena S, Rehman MU, Doshi R, Krishnan P. PERSISTENT HOARSENESS OF VOICE IN A SARCOID PATIENT: A CLUE TO LARYNGEAL SARCOIDOSIS; A POTENTIAL CAUSE OF UPPER AIRWAY OBSTRUCTION. Chest 2005. [DOI: 10.1378/chest.128.4_meetingabstracts.465s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
Sarcoidosis rarely affects the head and neck and represents a diagnostic challenge to the otolaryngologist. The signs and symptoms of sarcoidosis in this area are not specific and can mimic much more common disorders. Biopsy is usually necessary to make the diagnosis. Appropriate evaluations and referrals should be made once there is suspicion of sarcoidosis. Steroids remain the mainstay of the therapeutic options; however, newer agents are being used more frequently. Long-term treatment and follow-up are necessary, because the disease tends to progress and to respond unpredictably to treatment.
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Affiliation(s)
- Heather R Schwartzbauer
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, Ohio 45267, USA
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Abstract
Sarcoidosis is a chronic granulomatous disease that tends to involve the lungs, hilar and mediastinal lymph nodes, liver, eyes, skin, bones, and nervous system. Sarcoidosis involves the larynx less commonly than it afflicts these other sites. Laryngeal sarcoidosis may occur in isolation or as a component of systemic sarcoidosis and it may produce hoarseness, dysphagia, and dyspnea. Life-threatening airway obstruction can occur. Treatments used for laryngeal sarcoidosis have included tracheotomy, low-dose radiation, surgical excision, systemic steroids, and intralesional steroids. An autoimmune etiology has been suggested. The patient reported in this manuscript showed marked, sustained improvement following the use of inhaled steroids prescribed for obstructive pulmonary disease. The possible efficacy of steroid inhalers for treatment of laryngeal sarcoidosis warrants further investigation.
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Affiliation(s)
- Carole M Dean
- Department of Otolaryngology--Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Ridder GJ, Strohhäcker H, Löhle E, Golz A, Fradis M. Laryngeal sarcoidosis: treatment with the antileprosy drug clofazimine. Ann Otol Rhinol Laryngol 2000; 109:1146-9. [PMID: 11130828 DOI: 10.1177/000348940010901212] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sarcoidosis is a chronic systemic granulomatous disease that occasionally affects the larynx. When the larynx is affected, the symptoms are frequently mild, but severe airway obstruction can occur. Although systemic corticosteroids are helpful, patients may become refractory to further drug administration. The current methods of treatment are here summarized, and the patient literature is reviewed. We also report a case of a young patient suffering from laryngeal sarcoidosis successfully treated by the antileprosy agent clofazimine and propose it as an alternative treatment of laryngeal sarcoidosis in patients refractory to corticosteroids.
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Affiliation(s)
- G J Ridder
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert-Ludwigs-University, Freiburg, Germany
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McLaughlin RB, Spiegel JR, Selber J, Gotsdiner DB, Sataloff RT. Laryngeal sarcoidosis presenting as an isolated submucosal vocal fold mass. J Voice 1999; 13:240-5. [PMID: 10442754 DOI: 10.1016/s0892-1997(99)80027-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sarcoidosis can affect the larynx as a manifestation of systemic disease or as isolated laryngeal involvement. Classically, laryngeal involvement affects the supraglottis, and less commonly the subglottis, and true vocal fold involvement is rare. The clinical course is often highlighted by frequent exacerbations and remissions that, when associated with vague complaints and constitutional symptoms, are probably the greatest contributor to delayed presentation and diagnosis. We describe an unusual case of sarcoidosis that presented after a long and protracted clinical course as an isolated submucosal vocal fold mass requiring deep biopsy for diagnosis. A review of the literature with emphasis on diagnosis, appropriate airway management, and treatment is presented.
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Affiliation(s)
- R B McLaughlin
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospitals of the University of Pennsylvania, Philadelphia, USA
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Affiliation(s)
- S Fortune
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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