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To the Editor: In their Contempo Updates article about sarcoidosis, Drs Thomas and Hunninghake did not discuss otolaryngologic features, such as nasal congestion or bleeding, which can lead to early diagnosis.¹ In the Washington, DC, area, about 30% of patients have otolaryngologic manifestations and in about 20% the presenting symptom is due to involvement of the upper aerodigestive tract, the cervical lymph nodes, or the salivary glands.^2-3 The onset of unexplained cough should prompt an otolaryngologic evaluation since the cough may be caused by laryngotracheal sarcoidosis. Indeed, the upper airway is a frequent target organ of the most important diagnostic differentials of sarcoidosis including Wegener granulomatosis, fungal and mycobaterial infections, rhinoscleroma, relapsing polychondritis, T-cell lymphoma, and AIDS.⁴ All these multisystem diseases may present with nasal stuffiness and crusting, and hence, can be diagnosed early by nasal biopsy.⁵ Clearly, the nose would be much more accessible than the lungs.

Ziad E. Deeb, MD
Department of Head and Neck Surgery
MEDStar Health

Todd D. Otteson, MD
Department of Otolaryngology
Washington Hospital Center
Washington, DC

1. Thomas KW, Hunninghake GH. Sarcoidosis. JAMA. 2003;289:3300-3303. FREE FULL TEXT 2. Sneller MC. Wegener's granulomatosis. JAMA. 1995;273:1288-1291. FREE FULL TEXT 3. Shah UK, White JA, Gooey JE, Hybels RL. Otolaryngologic manifestations of sarcoidosis: presentation and diagnosis. Laryngoscope. 1997;107:67-75. PUBMED 4. Case records of the Massachusetts General Hospital: weekly clinicopathological exercises, Case 2-1990: a 63-year-old woman with bilateral maxillary sinus opacification and mediastinal lymphadenopathy. N Engl J Med. 1990;322:116-123. WEB OF SCIENCE | PUBMED 5. Lerner DM, Deeb ZD. Acute upper airway obstruction resulting from systemic disease. South Med J. 1993;86:623-627. PUBMED

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:1454.

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