Osteopathic Medical Student Noorda College of Osteopathic Medicine Provo, Utah
Introduction: Bamboo nodes are vocal cord lesions that are often associated with autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and Sjogren syndrome. Often women are affected by these lesions as well as those who partake in occupations involving significant use of their voice (i.e. teachers, singers). Clinically, these lesions can manifest symptoms of voice hoarseness and dysphonia as a consequence of vocal misuse or overuse. Endoscopically, these lesions are transversally arranged in the submucosal space displaying a yellow cystic consistency and were coined as bamboo nodes due to their resemblance of bamboo joints.
Case Study: This case involves a 43-year-old female who presents with complaints of voice hoarseness and dysphonia since December 2022. The patient had a history of singing often, but had not been able to sing normally for the past 10 months. Upon examination with a laryngoscope, the patient’s vocal cords displayed bilateral yellow lesions characteristic of bamboo nodes. Given that bamboo nodes are typically caused by autoimmune disease, an autoimmune blood test panel was conducted. The results showed positive antinuclear antibody (ANA), elevated rheumatoid factor (RF), and elevated Sjogren syndrome type A and B (SSA/SSB) antibodies. The treatment plan recommended voice therapy and exercises to soften the nodules. Additionally, the patient was referred to a rheumatologist to gain a better understanding of her immunological profile and underlying disease.
Discussion: Ultimately, this case is osteopathically relevant given the importance of vocal cord structure in the ability of this patient to be able to sing again and promotes the patient’s ability to self-heal through voice therapy and exercises. Other cases in the literature showcase the association of bamboo nodes with acute exacerbations of autoimmune disease rather than inactive states which can help guide treatment. Therefore, this case is particularly interesting due to the presence of bamboo nodes in an otherwise healthy female with possible underlying autoimmune disease that was never previously diagnosed. This case emphasizes the importance of clinicians to closely evaluate one’s history and perform a comprehensive immunological profile to detect these lesions in individuals who may not have a formal autoimmune disease diagnosis. Although this case is not entirely different from previous accounts of bamboo nodes, it provides additional information to guide clinicians on identifying this rare condition and promotes the osteopathic philosophy that treatment involves understanding one’s body unity, self-regulation, and the interconnectedness of structure and function.
