title: Laryngeal manifestations of relapsing polychondritis and a novel treatment option.
abstract: OBJECTIVE
  Laryngotracheal involvement in relapsing polychondritis (RP) is rare. However, it is one of the most common causes of death in this patient population. We present three patients who primarily presented with laryngeal manifestations of RP and a novel treatment option for bamboo nodules.
  
  
  METHODS
  Retrospective chart review and comprehensive review of the literature.
  
  
  RESULTS
  Two patients first presented to an otolaryngologist because of hoarseness and chronic cough that eventually progressed to dyspnea upon exertion. Laryngeal examination revealed subglottic stenoses. Upon rheumatologic workup both were diagnosed with RP. After treatment with steroids and immunosuppressive drugs, one of the patient's laryngeal symptoms improved, whereas the other required dilation procedures. Neither patient had classic auricular or nasal symptoms upon initial presentation. The third patient was being treated for spasmodic dysphonia and was noted to have bamboo nodules with accompanying dysphonia. Rheumatologic workup revealed RP and systemic treatment ensued. Unfortunately, her symptoms of hoarseness persisted despite systemic treatment. A pulsed-potassium-titanyl-phosphate (KTP) laser was applied to the bilateral bamboo nodules, which eventually caused resolution of her vocal fold lesions and dysphonia.
  
  
  CONCLUSIONS
  We present three patients with RP, all of whom sought health care by an otolaryngologist primarily. Awareness of this disease entity and the possibility for early laryngeal involvement is crucial for proper care of those with this life-threatening disease.
authors.affiliation: New York Head and Neck Institute, Center for Voice and Swallowing Disorders, New York City, New York 10019, USA. childs.lesley@gmail.com
authors.forename: Lesley F
authors.initials: LF
authors.lastname: Childs
authors.forename: Scott
authors.initials: S
authors.lastname: Rickert
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Wengerman
authors.forename: Robert
authors.initials: R
authors.lastname: Lebovics
authors.forename: Andrew
authors.initials: A
authors.lastname: Blitzer
mesh_terms: D000328:Adult; D003371:Cough / Q000209:etiology / Q000628:therapy; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D004724:Endoscopy; D005260:Female; D006685:Hoarseness / Q000209:etiology / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007829:Laryngostenosis / Q000209:etiology / Q000628:therapy; D007830:Larynx / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D053685:Laser Therapy / Q000295:instrumentation; D053844:Lasers, Solid-State / Q000627:therapeutic use; D008297:Male; D011081:Polychondritis, Relapsing / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013256:Steroids / Q000627:therapeutic use*; D014135:Tracheal Stenosis / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids