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Vocal cord lesions in representative autoimmune diseases. Clin Rheumatol 2023; 42:929-939. [PMID: 36269532 DOI: 10.1007/s10067-022-06411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/19/2022] [Accepted: 10/11/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to describe the clinical features of vocal cord lesions in patients with representative autoimmune diseases including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). METHOD A total of 31 SLE/RA patients (14 SLE and 17 RA) complicated with vocal cord lesions (SLE/RA-VC group) who had been admitted to Peking Union Medical College Hospital were retrieved from the electronic registration system. Ninety-three age and sex-matched SLE/RA patients (42 SLE and 51 RA) without vocal cord lesions (SLE/RA-nVC group) admitted during the same period were chosen randomly as controls. Medical files were reviewed and clinical data collected for comparisons. RESULTS Vocal cord paralysis (n = 12, 38.7%) and vocal cord mass (n = 14, 45.2%) were the most common types of vocal cord lesions in this cohort. Unilateral lesions were more common than bilateral lesions (67.8% vs 32.3%) and the two sides were affected equally. Two cases of vocal cord bamboo node lesion were observed in SLE-VC group even as an initial manifestation and SLE-VC group had a slightly higher disease activity index (SLEDAI-2K) than their control counterparts (18.56 ± 8.23 vs 13.63 ± 5.89, p = 0.041). The RA-VC group had less pulmonary interstitial disease (29.4% vs 63%, p = 0.017) and lower CRP levels (p = 0.006) than their controls. As for the treatment, 71% of SLE/RA-VC patients had received glucocorticoids and immunosuppressants and 30% had undergone surgery. 45.2% of SLE/RA-VC patients got improvement at the time of discharge. CONCLUSIONS The association of vocal cord lesions with disease activity can be observed in SLE patients but not in RA patients. Vocal cord lesions in SLE/RA patients should be considered as a part of the systemic involvement and should be treated accordingly. Key Points • Vocal cord paralysis and vocal cord mass were the main types of vocal cord lesions in patients with SLE/RA. • Vocal cord lesions in SLE patients may associate with disease activity and vocal cord bamboo node lesions could be an initial manifestation. • Glucocorticoid and immunosuppressants could be effective for vocal cord lesions in SLE/RA patients.
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Chapa JDL, Jonas RH, Weidman AA, Lear T, Strumpf A, Joshua K, McGarey PO. Autoimmune Associated Vocal Fold Lesions: A Systematic Review. J Voice 2022:S0892-1997(22)00390-3. [PMID: 36543608 DOI: 10.1016/j.jvoice.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE While Autoimmune Associated Vocal Fold Lesions (AaVFLs) have been described in many reports, there is no consensus on best practices in management. The purpose of this systematic review is to clarify the characteristics and treatment of dysphonia in the setting of AaVFLs. STUDY DESIGN Systematic review METHODS: Pubmed and OVIDMedline and Google Scholar were searched, including terms related to (1) Vocal fold/cord, rheumatoid node/nodule, bamboo nodes/nodules, laryngeal deposits/nodes/nodules and (2) Autoimmune diseases/syndromes, connective tissue disease. RESULTS Twenty-one studies with 83 patients diagnosed with AaVFLs were included. AaVFLs occurred predominantly in females in the 4th or 5th decade of life, with an overall mean age of 39.8 (SD = 12.8). Autoimmune or connective tissue disease was established prior to presentation to an otolaryngologist in 75.9% (44/58) of patients. Bilateral lesions were present in 83.8% (57/68) of patients. Treatment modalities included medical therapy alone (28.1%), voice therapy alone (17.5%), surgical treatment alone (7.0%), combination of medical and voice therapy (33.3%), and combination of surgical, medical and voice therapy (7.0%). All patients treated with voice therapy had voice improvement; lower rates were seen with solo medical (4/14 improved, 28.6%) or surgical therapy (3/6 improved, 50%). CONCLUSION AaVFLs occur predominantly in women in their 30's to 50's and are associated with a variety of autoimmune conditions. A significant number of patients (25%) present to the Otolaryngologist without an established autoimmune diagnosis. While treatment outcomes are not robustly reported, a significant number of patients with AAVFLs treated with voice therapy alone or voice therapy in combination with other treatment modalities (medical or surgical) experience subjective improvement in voice quality and function.
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Affiliation(s)
- Julian De La Chapa
- University of Virginia Department of Otolaryngology - Head and Neck Surgery, Charlottesville, Virginia
| | - Rachel H Jonas
- University of Virginia Department of Otolaryngology - Head and Neck Surgery, Charlottesville, Virginia.
| | - Allan A Weidman
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Taylor Lear
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Andrew Strumpf
- University of Virginia Division of Infectious Diseases, Charlottesville, Virginia
| | - Kate Joshua
- University of Virginia Health Sciences Library, Charlottesville, Virginia
| | - Patrick O McGarey
- University of Virginia Department of Otolaryngology - Head and Neck Surgery, Charlottesville, Virginia
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Han L, Chen Z, Yu K, Yan J, Li T, Ba X, Lin W, Huang Y, Shen P, Huang Y, Qin K, Geng Y, Liu Y, Wang Y, Tu S. Interleukin 27 Signaling in Rheumatoid Arthritis Patients: Good or Evil? Front Immunol 2022; 12:787252. [PMID: 35058928 PMCID: PMC8764250 DOI: 10.3389/fimmu.2021.787252] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022] Open
Abstract
The occurrence and development of rheumatoid arthritis (RA) is regulated by numerous cytokines. Interleukin 27 (IL-27) is a soluble cytokine that exerts biological effects by regulating the Janus tyrosine kinase (JAK)/signal transducer and activator of the transcription (STAT) signaling pathway via the IL-27 receptor. IL-27 is known for its pleiotropic roles in modulating inflammatory responses. Previous studies found that IL-27 levels are elevated in RA blood, synovial fluid, and rheumatoid nodules. Cellular and animal experiments indicated that IL-27 exerts multiple regulatory functions in RA patients via different mechanisms. IL-27 inhibits ectopic-like structure (ELS) formation and CD4+ T helper type 2 (Th2) cell, CD4+ T helper type 17 (Th17) cell, and osteoclast differentiation in RA, contributing to alleviating RA. However, IL-27 promotes Th1 cell differentiation, which may exacerbate RA synovitis. Moreover, IL-27 also acts on RA synovial fibroblasts (RA-FLSs) and regulatory T cells (Tregs), but some of its functions are unclear. There is currently insufficient evidence to determine whether IL-27 promotes or relieves RA. Targeting IL-27 signaling in RA treatment should be deliberate based on current knowledge.
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Affiliation(s)
- Liang Han
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhe Chen
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Kun Yu
- Department of Cardiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Jiahui Yan
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Li
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xin Ba
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Weiji Lin
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yao Huang
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Pan Shen
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Ying Huang
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Kai Qin
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yinhong Geng
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yafei Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Wang
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Shenghao Tu
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Tunç Songur E, Türkcan AK, Karadeniz H, Avanoğlu Güler A, Yapar D, Öztürk MA, Yılmaz M. Determination of the Voice Parameters in Adult Individuals With Rheumatoid Arthritis and the Relation of Voice With Depression and Inflammation. J Voice 2020; 36:880.e5-880.e12. [DOI: 10.1016/j.jvoice.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
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Timashpolsky A, Hutnik R, Mortensen MM. Rheumatoid Nodule of the Vocal Fold With Spontaneous Regression From Immunosuppressant Therapy. EAR, NOSE & THROAT JOURNAL 2019; 99:296-297. [PMID: 31072194 DOI: 10.1177/0145561319849379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Robert Hutnik
- Division of Otolaryngology-Head and Neck Surgery (ENT), Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Melissa M Mortensen
- Division of Otolaryngology-Head and Neck Surgery (ENT), Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
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Villalobos-Sánchez L, Bachiller-Corral J, Yeguas-Ramírez L, Cobeta-Marco I, Vázquez-Díaz M. Bamboo nodes as evidence of mixed connective tissue disease. Joint Bone Spine 2019; 86:645-646. [PMID: 30597217 DOI: 10.1016/j.jbspin.2018.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Lourdes Villalobos-Sánchez
- Department of rheumatology, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9,100. PC 28034, Madrid. Spain.
| | - Javier Bachiller-Corral
- Department of rheumatology, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9,100. PC 28034, Madrid. Spain
| | - Laura Yeguas-Ramírez
- Department of otorhinolaryngology, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9,100. PC 28034, Madrid. Spain
| | - Ignacio Cobeta-Marco
- Department of otorhinolaryngology, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9,100. PC 28034, Madrid. Spain
| | - Mónica Vázquez-Díaz
- Department of rheumatology, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9,100. PC 28034, Madrid. Spain
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Todic J, Schweizer V, Leuchter I. Bamboo Nodes of Vocal Folds: A Description of 10 Cases and Review of the Literature. Folia Phoniatr Logop 2018; 70:1-7. [PMID: 29847817 DOI: 10.1159/000487925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 02/22/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Bamboo nodes are vocal fold lesions, mostly associated with autoimmune diseases. PATIENTS AND METHODS This is a retrospective clinical study including 10 patients with bamboo nodes. Data were collected regarding associated autoimmune disorder and type of treatment. A systematic review of the literature was conducted. RESULTS All patients were women, with hoarseness as the most frequent symptom. There was in most cases an associated autoimmune disease: 3 patients with systemic lupus erythematosus; 3 with rheumatoid arthritis; 1 with Sjögren syndrome; 1 with Hashimoto disease; and 1 with mixed connective tissue disease. Four patients were treated with speech therapy, 3 with oral steroids, 1 with speech therapy and oral steroids combined, 1 with oral steroids and laryngeal steroid injections, and 1 had oral steroids, surgery, and speech therapy. Speech therapy was the first-line treatment. CONCLUSION Bamboo nodes should be looked for in every patient with a diagnosis of autoimmune disease complaining of dysphonia.
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Affiliation(s)
- Jelena Todic
- Department of Otorhinolaryngology, Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland
| | - Valérie Schweizer
- Department of Otorhinolaryngology, Faculty of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Igor Leuchter
- Department of Otorhinolaryngology, Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland
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Galli J, Marchese MR, De Canio C, Di Salvo M, Olivieri I, Santandrea L, Paludetti G. The prevalence of dysphonia and dysphagia in patients affected by immunomediated diseases and the role of psychometric tests. Clin Rheumatol 2018; 38:77-84. [PMID: 29728930 DOI: 10.1007/s10067-018-4129-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 04/24/2018] [Indexed: 12/20/2022]
Abstract
This cross-sectional investigation examined the prevalence and severity of dysphonia, globus pharyngeus, and dysphagia in patients affected by immunomediated (IM) diseases. Seventy subjects were administered the Voice Handicap Index (VHI) (scale 0-4), Glasgow-Edinburgh Throat Scale (GETS) (scale from 0 to 7) for globus pharyngeus assessment, and modified Swallowing Outcomes After Revised Laryngectomy (SOAL) (scale 0, 1, 2) to test swallowing symptoms. VHI: the mean percentage of answers with a score greater than 1 (corresponding to a frequency of situation's occurrence "sometimes," "almost always," or "always") was 25.7, 26.7, and 44.1% for functional, emotional, and physical groups of sub-items respectively. GETS: the mean percentage of answers with a score ≥ 3 was 60.85%, significantly higher if compared with that of answers with a score < 3 (40.14%). The mean percentages of answers with a score 0-2, 3-4, and 5-7 were 40.1, 16.7, and 43.7% respectively. SOAL: a mean of 57.9% of answers gained a symptomatic score (1 ["a little"] or 2 ["a lot"]) and 41.9%, the score 0. The difference was statistically significant (p < 0.05). The first two most recurrent items with a score 2 ("a lot") were "Do you have a problem swallowing dry food?" (46%) and "Do you have a problem swallowing solid food?" (36%). The study represents the first to describe the globus pharyngeus symptoms in IM population. Moreover, it allows to confirm the recurrence of dysphonia and dysphagia in this type of patients. Particularly, it has been demonstrated that the alteration of swallowing function is related to solid and dry food. The self-assessment questionnaires proved as a useful tool to early detection of dysfunctions in order to avoid further deterioration of quality of life and to prevent serious life-threatening complications.
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Affiliation(s)
- J Galli
- Department of Head and Neck Surgery, Catholic University of Sacred Heart, Policlinico "A. Gemelli" Foundation, Rome, Italy
| | - M R Marchese
- Department of Head and Neck Surgery, Catholic University of Sacred Heart, Policlinico "A. Gemelli" Foundation, Rome, Italy.
| | - C De Canio
- ENT Department, "San Carlo" Hospital, Potenza, Italy
| | - M Di Salvo
- ENT Department, "San Carlo" Hospital, Potenza, Italy
| | - I Olivieri
- Rheumatology Department of Lucania, "San Carlo" Hospital of Potenza and "Madonna delle Grazie" Hospital of Matera, Potenza, Italy
| | - L Santandrea
- ENT Department, "San Carlo" Hospital, Potenza, Italy
| | - G Paludetti
- Department of Head and Neck Surgery, Catholic University of Sacred Heart, Policlinico "A. Gemelli" Foundation, Rome, Italy
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Kim M, Sadoughi B. The Voice of Autoimmunity: Antisynthetase Syndrome Manifesting as Vocal Fold Bamboo Nodes. Ann Otol Rhinol Laryngol 2017; 127:128-130. [PMID: 29241348 DOI: 10.1177/0003489417748331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe a case of vocal fold bamboo nodes leading to the diagnosis of antisynthetase syndrome, a rare autoimmune disorder. To highlight the link between these laryngeal lesions and autoimmunity. METHODS A case of vocal fold bamboo nodes in a patient with long-standing interstitial lung disease is presented. The presence of these characteristic lesions prompted a rheumatologic workup that led to the diagnosis of a rare autoimmune disorder. RESULTS The patient was ultimately diagnosed with antisynthetase syndrome, a rare condition characterized by inflammatory myositis and interstitial lung disease. She was treated with steroids and immunosuppressive agents with improvement in her symptoms and clinical findings. CONCLUSIONS Vocal fold bamboo nodes are pathognomonic signs of autoimmunity. Management consists primarily of medical treatment of the underlying systemic disorder. Intralesional steroid injection or phonomicrosurgical excision may be considered for refractory cases.
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Affiliation(s)
- Matthew Kim
- 1 Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Babak Sadoughi
- 1 Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
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10
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Osipenko EV, Kotel'nikova NM. [The autoimmune rheumatic disease and laryngeal pathology]. Vestn Otorinolaringol 2017; 82:80-84. [PMID: 29072672 DOI: 10.17116/otorino201782580-84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vocal disorders make up one of the autoimmune pathological conditions characterized by multiple organ system dysfunction. Laryngeal pathology in this condition has an autoimmune nature; it is highly diverse and poorly explored. The objective of the present work based on the analysis of the relevant literature publications was to study clinical manifestations of the autoimmune rheumatic disease affecting the larynx. 'Bamboo nodes' on the vocal folds is a rare manifestation of laryngeal autoimmune diseases. We found out references to 49 cases of this condition in the available literature. All the patients were women presenting with autoimmune diseases. The present review highlights the problems pertaining to etiology of 'bamboo nodes' on the vocal folds and the method for the treatment of this condition.
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Affiliation(s)
- E V Osipenko
- State Scientific Clinical Centre of Otorhinolaryngology, Federal Medico-Biological Agency, Moscow, Russia, 123182
| | - N M Kotel'nikova
- State Scientific Clinical Centre of Otorhinolaryngology, Federal Medico-Biological Agency, Moscow, Russia, 123182
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Affiliation(s)
- Sara Immerman
- New York University School of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Kosztyła-Hojna B, Moskal D, Kuryliszyn-Moskal A. Parameters of the assessment of voice quality and clinical manifestation of rheumatoid arthritis. Adv Med Sci 2015. [PMID: 26197080 DOI: 10.1016/j.advms.2015.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study was to investigate the voice quality parameters in 72 rheumatoid arthritis (RA) patients and their relationships with the clinical manifestations and disease activity. The control group consisted of 30 healthy subjects. MATERIAL AND METHODS All RA patients were evaluated by extensive clinical, laboratory and radiographic studies. The phoniatric assessment included the analysis of vocal folds vibrations by digital stroboscopy (DS) of the larynx using HRES ENDOCAM 5562 system, digital kymography (DKG) and High-Speed Digital Imaging (HSDI) technique. The acoustic voice analysis was conducted using DiagnoScope Specialist program. RESULTS Voice quality disorders were registered in 32 (44.44%) RA patients and observed more frequently in patients with moderate and severe activity (DAS28≥3.2) than in mild RA. In digital stroboscopy, confirmed by digital kymography, the hypofunctional dysphonia was observed especially in patients with DAS28≥3.2. Outcomes of the subjective assessment of voice quality were in accordance with the objective parameters and acoustic voice examination. CONCLUSIONS In RA patients the most frequent voice quality disorders with hypofunctional dysphonia were registered. The relationships between voice quality disorders, clinical activity and radiographic progression of RA patients were observed. Digital stroboscopy, digital kymography, High-Speed Digital Imaging and acoustic voice analysis used in the complex diagnosis of RA confirmed the presence of pathological changes in the larynx. There is a need of cooperation between rheumatologists and phoniatricians in the diagnosis and treatment of dysphonia in RA patients.
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Iacovou E, Vlastarakos PV, Nikolopoulos TP. Laryngeal Involvement in Connective Tissue Disorders. Is it Important for Patient Management? Indian J Otolaryngol Head Neck Surg 2014; 66:22-9. [PMID: 24533356 PMCID: PMC3918331 DOI: 10.1007/s12070-012-0491-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 01/19/2012] [Indexed: 10/28/2022] Open
Abstract
Connective tissue disorders (CTDs) involve multiple organ systems and may have a significant impact on the overall health and quality of life of the affected individuals. The present paper aims to review the current knowledge on the laryngeal manifestations of CDTs, and describe the available diagnostic and treatment options. Systematic literature review in Medline and other database sources. Information from related books was also included. Prospective controlled, double-blind prospective, prospective, and transversal cohort studies, case series, case reports, systematic reviews, and consensus papers. Laryngeal involvement mostly occurs in rheumatoid arthritis (13-75% of patients). It is not uncommon in active and progressive clinical course, though can also occur in silent or inactive CDTs. The crico-arytenoid joint is the most commonly affected site. Common symptoms include throat pain, dyphonia and hoarseness. Careful clinical assessment of the larynx by flexible naso-endoscopy, video-stroboscopy, or direct laryngoscopy, and appropriate imaging are required for pertinent patient management. Stridor is a sign of a life-threatening condition, and may require prompt surgical intervention. However, mild symptomatology may mislead clinicians, and the related diagnosis may be significantly delayed. The current evidence as identified in the present study suggest that laryngeal manifestations of CDTs are often underdiagnosed, due to a range of non- specific symptoms. A multidisciplinary team approach with ENT input is necessary to improve the overall patient management.
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Affiliation(s)
- Emily Iacovou
- />ENT Department, General Hospital of Larnaca, Larnaca, Cyprus
| | - Petros V. Vlastarakos
- />ENT Department, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB UK
- />33 Wetherby Close, Stevenage, Hertfordshire SG1 5RX UK
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Beirith SC, Ikino CMY, Pereira IA. Laryngeal involvement in rheumatoid arthritis. Braz J Otorhinolaryngol 2013; 79:233-8. [PMID: 23670331 PMCID: PMC9443909 DOI: 10.5935/1808-8694.20130040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/11/2013] [Indexed: 11/25/2022] Open
Abstract
Abstract The prevalence of laryngeal involvement in Rheumatoid Arthritis (RA) ranges from 13 to 75%. The specific RA manifestations include the cricoarytenoid arthritis and the presence of rheumatoid nodules in the vocal folds. Objective The objective of this study is to evaluate the prevalence of dysphonia and laryngeal alterations on videolaryngoscopy in RA patients and their association with disease activity. Method This is a clinical cross-sectional study that evaluated patients with rheumatoid arthritis as to their disease activity score in 28 joints (DAS-28), laryngeal symptoms, application of a Portuguese version of the Voice Handicap Index and videolaryngoscopy findings, comparing them with a control group. Results We evaluated 47 (54%) patients with rheumatoid arthritis and 40 (46%) controls. The prevalence of dysphonia and videolaryngoscopy changes was respectively 12.8% and 72.4% in patients with RA. The mean of DAS-28 was 3.3 ± 1.2; 26 (74.3%) of 35 patients presenting active disease had laryngeal changes (p = 0.713). Posterior laryngitis was the most common diagnosis (44.7%). Conclusion The prevalence of laryngeal disorders in RA patients was 72.4% and the prevalence of dysphonia was 12.8%. There was no significant relationship between laryngeal disorders and disease activity.
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Laryngeal manifestations of rheumatoid arthritis. Autoimmune Dis 2013; 2013:103081. [PMID: 23864939 PMCID: PMC3707215 DOI: 10.1155/2013/103081] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/23/2013] [Indexed: 12/23/2022] Open
Abstract
Rheumatoid arthritis is a destructive autoimmune disease that affects 3% of the adult population. It is characterized by the formation of both articular and extra-articular lesions with predilection for small joints. There are ubiquitous reports on the head and neck manifestations of RA with emphasis on the larynx. The laryngeal presenting features of this systemic disease may mimic a plethora of medical conditions, inflammatory and neoplastic. The main phonatory and respiratory symptoms are often subtle and misleading. This paper represents a literature review of the laryngeal manifestations of RA with emphasis on the clinical symptoms, laryngeal findings, diagnosis, and treatment. An early diagnosis of laryngeal involvement may prevent drastic complications.
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Sanz L, Sistiaga J, Lara A, Cuende E, García-Alcántara F, Rivera T. The Prevalence of Dysphonia, Its Association With Immunomediated Diseases And Correlation With Biochemical Markers. J Voice 2012; 26:148-53. [DOI: 10.1016/j.jvoice.2011.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
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Schwemmle C, Kreipe HH, Witte T, Ptok M. Bamboo nodes associated with mixed connective tissue disease as a cause of hoarseness. Rheumatol Int 2011; 33:777-81. [PMID: 22083614 PMCID: PMC3576552 DOI: 10.1007/s00296-011-2214-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 10/22/2011] [Indexed: 12/04/2022]
Abstract
Vocal fold lesions related to autoimmune diseases are rheumatoid nodules and, to a lesser extent, bamboo nodes. Mostly transverse, they are located in the middle third of the vocal cord and exhibit a yellowish appearance. The characteristic shape of these lesions led to their name. These vocal fold deposits may interfere with the normal vibratory cycle during phonation and thus may be an unusual cause of hoarseness. We present a 43-year-old woman with known mixed connective tissue disease and a dysphonia. Laryngostroboscopy showed bamboo nodes as described above. We applied several laryngeal injections of cortisone as described previously in the literature. Since this treatment did not lead to a sufficient voice improvement, we attempted to surgically remove the deposits. After the surgery, the voice improved considerably. In all patients with rheumatic diseases who suffer from a rough, breathy, or unstable voice, a laryngostroboscopic examination should be done. If, however, a bamboo node lesion of the vocal folds is found by the laryngologists, an associated autoimmune disorder must be assumed, and adequate diagnostic procedures have to be initiated. Local laryngeal injections (1–3 times) with steroids should be the first line of therapy. In unsuccessful cases, subsequent surgery can be a useful treatment of bamboo nodes to stabilize and improve voice quality.
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Affiliation(s)
- Cornelia Schwemmle
- Department of Pedaudiology and Phoniatrics, Medical University Hannover, Hannover, Germany.
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Affiliation(s)
- Haiyan Wu
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Prevalence of subjective voice impairment in rheumatoid arthritis. Clin Rheumatol 2008; 27:1441-3. [PMID: 18716729 DOI: 10.1007/s10067-008-0994-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 10/21/2022]
Abstract
Rheumatoid arthritis (RA) might lead to voice impairment through several mechanisms but its prevalence has been little investigated. RA patients attending a rheumatology outpatient clinic had joint assessments and completed the Voice Handicap Index-10 (VHI-10). A comparator group consisted of patients attending the department with other diseases. Seventy-three patients with RA and 73 comparators were recruited. Four patients with RA (5%) and one comparator (1%) had significantly abnormal VHI-10 scores. RA patients with a Disease Activity Score 28 >3.2, indicating more active disease, had significantly higher VHI-10 scores. A low prevalence of self-reported voice handicap occurs in RA and associates with more active disease.
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Hilgert E, Toleti B, Kruger K, Nejedlo I. Hoarseness Due to Bamboo Nodes in Patients with Autoimmune Diseases: A Review of Literature. J Voice 2008; 22:343-50. [PMID: 17280816 DOI: 10.1016/j.jvoice.2006.10.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Indexed: 11/27/2022]
Abstract
SUMMARY This is a retrospective report on clinical features, laryngoscopic examinations, and follow-up markers of laryngeal manifestation described as bamboo nodes in three female patients with transverse cystic lesions of the vocal folds, treated with logopedic therapy. This study examines logopedic and phoniatric aspects in patients with submucosal "bamboo joint-like nodes" of both vocal folds, and reveals an improvement of different voice quality features after conservative traditional voice therapy. There still exists no standard treatment regimen in patients with rheumatoid disease of the larynx; a lack of consensus is most evident in the role of voice therapy. We would like to emphasize the favorable impact of logopedic therapy in benign laryngeal disorders with underlying autoimmune diseases.
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Affiliation(s)
- E Hilgert
- Department of Phoniatry and Pediatric Audiology, Ludwig-Maximilians University Munich, Munich, Germany.
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Abstract
BACKGROUND In rare cases, dysphonia can be caused by vocal fold deposits called "bamboo nodes." They often feature a transverse yellowish appearance of the middle third of the vocal cord, resembling a bamboo node. Typical histologic signs are similar to rheumatoid nodules. CASE REPORT We report on a 43-year-old woman with known Sharp syndrome and dysphonia. Laryngoscopy showed transverse deposits on both vocal folds. The diagnosis of bamboo nodes was made and treatment initiated. DISCUSSION/CONCLUSION Laryngeal deposits should be suspected and a thorough laryngostroboscopic examination carried out whenever a patient with an autoimmune disease presents with a rough and unstable voice. Because the patients may have hoarseness as their primary symptom, it is important for otolaryngologists to be familiar with this disorder. Further autoimmune investigation should be established. A combination of local laryngeal therapy with steroids and subsequent surgery seems to be a useful treatment approach for bamboo nodes. To our knowledge this is the first description of a patient with Sharp syndrome and bamboo nodes.
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Affiliation(s)
- C Schwemmle
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule, Hannover, Germany
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Speyer R, Speyer I, Heijnen MAM. Prevalence and relative risk of dysphonia in rheumatoid arthritis. J Voice 2006; 22:232-7. [PMID: 17074464 DOI: 10.1016/j.jvoice.2006.08.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 08/24/2006] [Indexed: 11/24/2022]
Abstract
SUMMARY Laryngeal involvement in rheumatoid arthritis is not uncommon and may include cricoarytenoid arthritis or vocal fold lesions such as vocal fold rheumatoid nodules or bamboo nodes. Dysphonia or voicing problems can be the result of such laryngeal involvement. This cohort study investigates the prevalence and the relative risk of dysphonia when suffering from rheumatoid arthritis compared to that of healthy subjects. One hundred and sixty-six subjects with rheumatic arthritis and 148 healthy control subjects completed two quality-of-life questionnaires: the Voice Handicap Index and a three-item outcome scale. Both instruments measure the quality of the voice itself and the extent of impairment resulting from dysphonia as experienced by the patient in social and occupational settings. Patients proved to have statistically significant higher prevalence and relative risk of dysphonia. Depending on the questionnaire being used, prevalence data of dysphonia in patients varied between 12% and 27%, whereas the healthy subjects showed prevalence data varying from about 3% to 8%. A patient's relative risk varied from about 3 to 4 when compared to healthy subjects. Patients suffering from rheumatoid arthritis have a clearly higher risk of dysphonia compared to healthy subjects.
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Affiliation(s)
- Renée Speyer
- Department of O.R.L. and Head and Neck Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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