Bamboo nodes are band-like, cream-coloured submucosal deposits affecting the middle third of the vocal cord. They are reported to affect women exclusively and are frequently bilateral but can be asymmetrical. They are distinct from vocal cord nodules but can be mistaken for them. They are associated with autoimmune diseases including SLE, RA, Sjogren syndrome, autoimmune hepatitis, Hashimoto thyroiditis and progressive systemic sclerosis. In this case series, the epidemiology of bamboo nodes in a series of 15 patients and the outcomes of a conservative management approach to the condition are described. As per previous data, all patients were female with a mean age of 38. Of these, 60% (9/15) had a known autoimmune diagnosis. Of the remaining six patients, two (13.3%) were diagnosed with an autoimmune condition (1 RA and 1 SLE) following serological testing arranged secondary to the identification of bamboo nodes. SLE, RA and Sjogren syndrome accounted for the majority of autoimmune diagnoses in this series. Voice therapy was offered to all patients. Medical treatments given to patients with a diagnosed underlying autoimmune disease to help with their voice symptoms included methotrexate, mycophenolate, and hydroxychloroquine. Voice rest was also found to be beneficial for some patients. Overall, 87% of patients reported improvement in their voice symptoms at follow-up. Phonosurgery was not performed for any of this cohort. This series is a useful reminder about a rare laryngeal condition and its relevant associations. The outcome data would also suggest that a conservative approach consisting of voice therapy and medication alteration/introduction for patients with a diagnosed autoimmune disease (overseen by a physician) represents the best initial management strategy, with surgery a last resort that was not required for the patients in this series.

Bamboo Nodes on a Series of 15 Patients: Vocal Fold Lesion as a Sign of Autoimmune Disease and Microphonotrauma.
Oker N, Julien-Laferriere A, Herman P, Chevaillier G.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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