Bamboo Nodes on a Series of 15 Patients: Vocal Fold Lesion as a Sign of Autoimmune Disease and Microphonotrauma

J Voice. 2019 May;33(3):357-362. doi: 10.1016/j.jvoice.2017.11.001. Epub 2017 Dec 11.

Abstract

Objectives: Bamboo nodes are band-like submucosal deposits of the middle third of the vocal fold. They are often related to connective tissue disorders, but can also precede them. The aim of this study was to report our experience with conservative treatment of those rare lesions.

Methods: This is a retrospective series of 15 patients consulting for hoarseness and presenting bamboo nodes from 2010 to 2016.

Results: All patients were women of mean age of 38 years with a moderate or high degree of daily vocal effort. Nine patients (60%) presented with known autoimmune disease at the phoniatric appointment. The other patients (40%) benefited from a systematic biological research for autoimmune disease, which retrieved two poorly symptomatic connective tissue disorders. Patients were clinically improved by speech therapy (53%) or by an optimization or introduction of immunosuppressive treatment (46%). A spontaneous improvement was observed for three patients after voice rest (one after retirement, one after professional change, and last one after resuming professional singing). In our series, no phonosurgery was performed. The vocal profile at last appointment found a moderate Voice Handicap Index at 35.3/120, a low maximum time of phonation at 13.6 seconds, and a high jitter at 1.4, sign of instability of the vibrator.

Conclusion: This series emphasizes the importance of diagnosing bamboo nodes in middle-aged female presenting an autoimmune disease. Vice versa for each patient with bamboo nodes, a systematic autoimmune check-up has to be realized to detect a biological asymptomatic autoimmune disease.

Keywords: Autoimmune disease; Bamboo nodes; Connective tissue disorder; Conservative treatment; Dysphonia.

Publication types

  • Multicenter Study

MeSH terms

  • Autoimmune Diseases / immunology
  • Autoimmune Diseases / pathology*
  • Autoimmune Diseases / physiopathology
  • Autoimmune Diseases / therapy
  • Hoarseness / immunology
  • Hoarseness / pathology*
  • Hoarseness / physiopathology
  • Hoarseness / therapy
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Laryngeal Diseases / immunology
  • Laryngeal Diseases / pathology*
  • Laryngeal Diseases / physiopathology
  • Laryngeal Diseases / therapy
  • Laryngoscopy
  • Paris
  • Phonation
  • Recovery of Function
  • Retrospective Studies
  • Speech Therapy
  • Treatment Outcome
  • Vocal Cords / immunology
  • Vocal Cords / pathology*
  • Vocal Cords / physiopathology
  • Voice Quality

Substances

  • Immunosuppressive Agents