全身性エリテマトーデス患者に生じた声帯結節と竹節状声帯に対する音声治療の経験

The authors experienced a case of vocal fold bamboo nodes which appeared along with vocal nodules in a 29-year-old woman who was diagnosed as systemic lupus erythematosus (SLE). The patient visited our outpatient clinic complaining of hoarseness. She exhibited a strong tendency of daily vocal abuse. An initial flexible laryngeal endoscopic examination revealed bilateral vocal fold nodules in the middle portion of the vocal folds and bilateral white bamboo nodes in the posterior third portion of the vocal folds. Stroboscopic examination showed asymmetrical vibratory phases of the mucosal wave and mild anteroposterior narrowing of the supraglottic space. To treat her functional problems, voice therapy was provided. Post-therapy examination demonstrated improvements in both self-evaluation and instrumental/clinical measures, although the vocal lesions remained the same. The causes of the bamboo nodes in this patient are suspected as follows: 1) The patient's vocal abuse caused vocal nodules in the middle portion of the vocal fold mucosa. 2) The presence of the vocal nodules increased the vibration of the membranes between the nodules and the process. 3) The increased vibration led to accumulation of immune complexes and subsequent bamboo nodes in the posterior third of the membranous vocal folds. This case report indicates that, in patients with SLE, although voice therapy does not solve the organic aspects of the problems, it is important for identifying functional components of the voice problems. We therefore view voice therapy as a valuable treatment option.