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Treatment Guidelines

The mainstay of treatment is medical therapy based upon steroid agents, which are effective in controlling the disease, either localized or systemic. Medical therapy has to be tailored to the length and severity of the disease and to the response of patients to the treatment itself. In the presence of complications, such as acute rhinosinusitis, antibiotics and decon-gestants must be administrated.

According to Krespi et al. (1995), three different stages of sinonasal sarcoidosis (mild, moderate, severe) may be recognized, according to the entity of the disease. Mild sinonasal tract involvement (Stage I) may be treated by topical steroids. Nasal irrigations and emollients play a role in removing crusts and necrotic tissue, thus avoiding bacterial superinfections and restoring more "physiologic" conditions for the mucosa. Stage II disease (moderate but reversible disease or mild disease not responsive to treatment) could benefit also from intra-lesional injections of steroids. Stage III sarcoidosis (severe, irreversible disease) must be treated also with systemic steroids.

Surgery should be reserved to symptomatic patients whose sinonasal involvement can not be treated with medical therapy. Events such as a complicated rhinosinusitis, mucocele, inflammatory adhesions, and obstructive polyposis are elective conditions for surgical treatment. As in other chronic inflammatory diseases, surgery in patients with sarcoidosis appears to be effective in the short term, but shows no satisfactory long-term outcomes (MArkS and GoodmAN 1998). In selected cases, persistent frontal sinusitis and headache may be effectively treated by osteo-plastic sinusotomy with fat obliteration (MArkS and GoodmAN 1998).

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