Bamboo node: Primary vocal fold lesion as evidence of autoimmune disease

Descriptions of vocal fold lesions related to autoimmune diseases are rare in the literature, and focus mainly on rheumatoid nodules. This is the firs t report in which autoimmune diseases were promptly suspected by the observ ation of a unique white transverse submucosal lesion in the vocal fold duri ng clinical examination. This lesion, reported only in autoimmune disease, has been called the bamboo node and its features are different from those o f rheumatoid nodules. We report here on two patients who did not have a dia gnosis of systemic disease before investigation of their main complaint of hoarseness. At the patients' first visit, vocal fold bamboo nodes were seen in the vocal fold and the otolaryngologist suspected the presence of an au toimmune disease. We requested clinical investigation to clarify our suspic ion that there was an underlying systemic disease. After the investigation, both patients were shown to have autoimmune disease, Sjogren's syndrome an d systemic lupus erythematous, respectively. This paper emphasizes the impo rtant role of the otolaryngologist in the detection of these unique lesions in the vocal folds through the conventional laryngeal methods. These metho ds consisted of direct observation with a rigid laryngeal endoscope and inv estigation of the patient's distinctive vibratory pattern by means of laryn geal stroboscopy. The method of treatment we used to obtain the best outcom e in terms of voice improvement is also discussed.