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.
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.
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
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.