Laryngeal sarcoid: Clinical presentation, management, and outcomes at a tertiary care center.

OBJECTIVE

Our study aimed to characterize the presenting features, interventions, and outcomes observed in patients with laryngeal manifestations of sarcoid (LS) managed at a tertiary care center.

STUDY

DESIGN

Retrospective case series.

SETTING

Icahn School of Medicine at Mount Sinai.

METHODS

Chart review including patients with LS treated between 1998 and 2012.

RESULTS

27 patients with LS were identified. The mean age at presentation was 47.1 years (range 23-65 years), and 12 patients (44.4 %) were male. Presenting symptoms were dyspnea (n = 16, 59.3 %), dysphonia (n = 14, 51.9 %), cough (n = 3, 11.1 %), and stridor (n = 1, 3.7 %). LS was identified in the supraglottis (n = 15, 55.6 %), glottis (n = 8, 29.6 %), isolated vocal fold paralysis (n = 5, 18.5 %), and subglottis (n = 5, 18.5 %). 23 patients (85.1 %) had extra-laryngeal manifestations. The most common systemic medications were prednisone (n = 17, 63.0 %) hydroxychloroquine (n = 4, 14.8 %), and plaquenil (n = 3, 11.1 %). Surgical interventions included office-based or operating room intralesional steroid injection in 13 (48.1 %), debulking (n = 10, 37.0 %), and tracheotomy (n = 5, 18.5 %, with 2 eventual decanulations). Median follow up was 19 months (range, 1-168 months), with 10/17 noting improvement or resolution of laryngeal findings, but only 1/14 with systemic manifestations showing improvement.

CONCLUSION

LS usually presents in the context of systemic sites of disease, and most commonly manifests in the supraglottis but it may occur in the glottis, subglottis and trachea. Patients may also present with isolated vocal paralysis related to mediastinal disease. While local management is often effective in the larynx, oral prednisone and other medications benefit systemic disease.