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Sinonasal sarcoidosis is a fairly uncommon, yet clinically challenging, manifestation of this systemic disease. The diagnosis is often difficult to establish, treatment options are often unclear, and ultimate clinical responses can be quite variable. This article discusses the varied clinical presentations of this unusual nasal inflammatory process, as well as various treatment options, from simple local nasal hygiene measures to more aggressive systemic therapy. Although the role of surgical intervention is controversial, a simple review of some of the indications for surgery in these patients helps to clarify this somewhat cloudy clinical area. Aggressive clinical management in conjunction with long-term surveillance can often produce dramatic clinical responses for these difficult patients with sarcoidosis in the sinonasal area.