Autoimmune-related dysphonia: vocal fold bamboo nodes

Bamboo nodes are rare and often-overlooked autoimmune lesions, arising from the upper surface of the vocal folds, with a transversal band-like appearance. To date, only few cases of such conditions have been described, but their actual prevalence is likely to be underestimated, since bamboo nodes may be mistaken for common vocal fold nodules. We herein describe the case of a female patient with mixed connective tissue disease, presenting with bamboo nodes, who responded to a multimodal treatment, including systemic immunosuppressants, vocal fold corticosteroid injection and speech therapy. A 43-year-old woman with mixed connective tissue developed progressive dysphonia. The first-line ENT evaluation showed bilateral nodular thickening of the vocal folds. The patient responded only slightly to speech therapy, so she was submitted to a second-level phoniatric evaluation, unveiling bamboo nodes. After a multidisciplinary discussion between the Phoniatric and Rheumatologic teams, the chosen therapeutic approach was adding a bilateral vocal fold corticosteroid injection to the baseline immunosuppressant therapy, followed by another course of ten speech therapy sessions. Two months after treatment, a significant reduction of bamboo nodes was found, along with an improvement in acoustic voice parameters. Such results remained stable over a five-month follow-up. To develop evidence-based approaches to vocal fold autoimmune lesions, a greater awareness regarding such conditions is advocated, also allowing for the accumulation of larger series.