Granulomatous diseases of the sinonasal tract

Abstract

Granulomatous diseases are rare causes of sinonasal inflammatory disease. Patients typically present with non-specific nasal airway obstruction with associated rhinorrhea and epistaxis. Physical examination yields a spectrum of findings ranging from normal appearing mucosa to polypoid nodular changes, adhesion formation, and extensive crusting to marked tissue destruction. Histopathology demonstrates the presence of granulomas, which represent foci of chronic inflammation that appear as aggregates of epithelioid macrophages surrounded by a collar of lymphocytes and occasional plasma cells. Many of these conditions can be very aggressive and timely diagnosis facilitated by a high index of suspicion, nasal endoscopy with biopsy, and serology where appropriate is critical. Advances in endoscopic technology and laboratory evaluation have led to a greater understanding and more appropriate disease-specific care. © 2009 Springer Berlin Heidelberg.