Voice Therapy and Vocal Fold Steroid Injection for Bamboo Nodes of the Vocal Folds: A Retrospective Case Series

Bamboo nodes of the vocal folds are rare autoimmune disease-associated lesions, and the optimal local treatment remains unclear. This study retrospectively evaluated the effects of voice therapy (VT) and vocal fold steroid injection (VFSI) with triamcinolone acetonide.

Six women diagnosed with bamboo nodes of the vocal folds between April 2019 and March 2024 were included. VT for 2 months was proposed as initial treatment, and VFSI was considered when subjective symptoms or objective findings improved insufficiently. Voice outcomes were assessed before and after VT in patients who received VT and before and 3 months after VFSI in patients who received VFSI, using aerodynamic, acoustic, patient-reported, and endoscopic measures. Pretreatment and post treatment values were compared for each modality using the Wilcoxon signed-rank test.

Five of six patients underwent treatment for dysphonia. Among four patients who received VT as initial treatment, maximum phonation time decreased from 12.4 to 10.5 seconds and mean flow rate increased from 219.4 to 299.6 mL/s, with no consistent improvement in acoustic measures, Voice Handicap Index, or glottal closure. Among four patients who underwent VFSI, maximum phonation time increased from 11.2 to 14.8 seconds, mean flow rate decreased from 286.3 to 181.0 mL/s, Voice Handicap Index decreased from 65.0 to 32.5, and glottal closure grade improved from 2 to 1. No statistically significant differences were observed, but changes in aerodynamic and patient-reported measures after VFSI showed large effect sizes. No treatment-related complications occurred.

The therapeutic effect of VT may be limited in some patients with bamboo nodes of the vocal folds. VFSI may improve phonatory efficiency, patient-reported voice handicap, and glottal closure and may be a useful minimally invasive local treatment option for selected cases. Larger prospective studies are needed.