Figure 4. Submucosal lymphocytes and neutrophil infiltration, with a little necrosis and eosinophil deposition.
4. Discussion
Many instances of bamboo nodes have been linked to systemic lupus erythematous (SLE) [2,3,4], although similar lesions have also been observed in individuals with rheumatoid arthritis, Sjogren’s disease, Hashimoto’s thyroiditis, and progressive systemic sclerosis [1]. Bamboo nodes is not a disease of voice fold itself, but rather a manifestation of underlying autoimmune diseases [5]. Bamboo nodes may sometimes appear before other symptoms arise, with a blood anomaly being the sole additional finding. The discovery of bamboo nodes does not necessarily result in multisystemic connective tissue syndrome. For years, bamboo nodes in some people seem to be the sole indication of disease [6]. Additionally, a few years of follow-up reveal a connection between autoimmune activity and bamboo nodes [7,8]. It has long been recognized that autoimmune illnesses may cause laryngeal symptoms. They may include vocal fold lesions such vocal fold rheumatoid nodules, mucous inflammation, subglottic stenosis, viscus litis, laryngeal edema, paralysis, and infection [4]. Bamboo nodes in the larynx are not often identified as an indication of an autoimmune illness. When an otolaryngologist examines them, he or she must search for any signs of an autoimmune condition that may be the cause. Similar to this, an internist should refer a patient with a speech problem who has an autoimmune illness to an otolaryngologist so they may check for bamboo nodes.
The origin of illnesses has also been the subject of other theories. According to Ramos et al., bamboo nodes may be the outcome of a local inflammatory response and are associated with autoimmune diseases [9]. Hosako-Naito et al. hypothesized that the vocal fold’s mucosal wave would result in mechanical damage that might result in bamboo nodes [10]. Li et al. proposed a hypothesis that took into account both mechanical micro-trauma and a local immunological response [11]. Until now, bamboo nodes have only been reported in women. They were usually found in professional speakers. Patients with an autoimmune disease or those who suffer from dysphonia should also be checked for these nodes [12].
Although it is unclear why bamboo nodes are exclusively seen in females, it is probably because women’s vocal folds tend to be smaller and vibrate at higher frequencies than men’s, which leads to a greater prevalence of nodules on the vocal folds in females [13]. This emphasizes the importance of having bamboo nodes checked for autoimmune diseases in middle-aged women. Likewise, for patients with bamboo nodes, a comprehensive check-up should be carried out to identify an asymptomatic autoimmune disease [14].
Submucosal edema, lymphocyte, and neutrophil infiltration, as well as fibrinoid necrosis all contribute to bamboo nodes on the vocal folds [2,3,7,10,13]. The patient’s vocal folds’ bamboo node immunofluorescence analysis revealed the presence of IgM, C1q, as well as IgA in the submucosal area. These findings demonstrate that immune complexes adversely adhere to the submucosa of bamboo nodes. It is in line with the pathological exam results of the patient, which showed submucosal lymphocytes, neutrophil infiltration, and a little amount of eosinophil deposition, as detailed in this paper.
When it comes to treating bamboo node illness, Murano confirms that bamboo nodes are a sign that the autoimmune disease is active [7]. Therefore, in a clinical situation, he holds the opinion that systemic steroids need to be tried initially. Oral steroids are used as the first therapy for the autoimmune illness and the laryngeal lesions. Hosako-Naito suggested totally eradicating the lesion to prevent it from recurrence [2]. According to Perouse, 19 patients were successfully treated with surgery [10]. According to the research, speech therapy may help patients avoid developing harmful vocal habits and minimize vocal microtrauma better than surgery or steroid treatments. Steroid therapy was used to treat the two instances discussed in this paper, and the patients’ symptoms had an improvement. And it is not ruled out that the use of surgical resection of bamboo nodes can be performed in patients with resistant to systemic or local therapy [15].
5. Conclusion
Bamboo nodes are rare, vocal cord bamboo knot disease can change the laryngeal characteristics of patients with immune diseases. The main pathological changes are submucosal lymphocyte and neutrophil infiltration. In the event that a patient has bamboo nodes on their vocal folds, they should schedule an appointment with their physician or have their immune system examined. Oral hormone conservative treatment can improve the symptoms, but the pathological changes are progressive, which can progress from unilateral to bilateral, and the symptoms are aggravated. As of today, there is no gold standard for therapies, nor is there a documented method of therapy that is widely accepted.
Patient consent
Written informed consent was obtained from the patient by the corresponding author. The signed consent forms were retained by the corresponding author. We anonymized the patient’s details as much as possible.
Funding
None.
Conflict of interest
None.
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