A patient with pulmonary sarcoidosis develops progressive inspiratory stridor. Endoscopy shows smooth pale supraglottic swelling centred on the epiglottis and arytenoids, with mobile vocal folds. What is the best management principle?
Laryngeal sarcoidosis often affects supraglottic tissue and can obstruct the airway. The team must assess airway urgency, exclude infection and malignancy by biopsy, then coordinate corticosteroid or other systemic therapy.
A. Secure the airway if threatened and obtain tissue confirmation before immunosuppressive treatment: Laryngeal sarcoidosis often affects supraglottic tissue and can obstruct the airway. The team must assess airway urgency, exclude infection and malignancy by biopsy, then coordinate corticosteroid or other systemic therapy.
B. Assume asthma and increase bronchodilators: A fixed supraglottic lesion will not respond to lower-airway treatment.
C. Perform total laryngectomy: This is disproportionate before tissue diagnosis and medical therapy.
D. Inject the vocal folds medially: The folds move normally and the obstruction is supraglottic.
E. Observe despite progressive stridor: Airway deterioration may be rapid and difficult to rescue.
If biopsy showed lymphoma or squamous carcinoma, disease-specific oncological management would replace sarcoid immunosuppression.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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