Nasal and sinus diseases are considered uncommon manifestations of sarcoidosis. We evaluated 159 consecutive patients with sarcoidosis for nasal symptoms. Sixty-three patients (39%) denied any nasal symptoms. Thirty-six patients (23%) had intermittent symptoms that lasted less than three weeks and required continuous intervention with nasal steroids or normal saline. Sixty patients (38%) were treated with nasal steroids and antibiotics for symptoms that lasted more than three weeks. Thirty-three patients (21%) had resolution of their symptoms after treatment with nasal steroids and antibiotics. Twenty-seven patients (17%) had symptoms that were unresponsive to three weeks of oral antibiotics and nasal steroids, and underwent CT scan. Based on the CT results, five patients underwent biopsy, which confirmed sarcoidosis. An additional patient who had a normal CT scan underwent a biopsy that was consistent with sarcoidosis. A retrospective review of 733 sarcoidosis patients was then performed, and an additional 12 patients were identified with biopsy-proven sarcoidosis. All of these patients required long-term therapy with prednisone (14 patients), methotrexate (13 patients), and/or azathioprine (8 patients). Our clinical study reveals a higher incidence of nasal and sinus disease in patients with sarcoidosis than has previously been described, and the recalcitrance of sarcoidosis when there is sinus involvement.