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Rheumatoid nodules and reflux disease.

A 21 -year-old singer with perennial allergies and reflux disease came to us with a l-year history of reduced range and a raspy speaking voice. On initial examination, she exhibited moderate vocal fold edema and erythema. She was prescribed a proton-pump inhibitor and an H2 blocker. A pH probe performed during therapy revealed that she was not having any breakthrough acid events.

On follow-up stroboscopy, the generalized edema had resolved, but several yellow subepithelial nodules were noted on both vocal folds. On further questioning, the patient admitted that she had arthritis in her hands that was severe enough to prevent her from playing her harp. She underwent a rheumatologic evaluation and was found to be positive for antinuclear antibodies (1:320); although her rheumatoid factor was negative, she was placed on hydroxyehloroquine sulfate therapy. She improved dramatically, and the nodules began to resolve.

From the Texas Voice Center, Houston.
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Article Details
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Title Annotation:Laryngoscopic Clinic
Author:Rodriguez, Margarita
Publication:Ear, Nose and Throat Journal
Article Type:Brief Article
Geographic Code:1USA
Date:May 1, 2004
Previous Article:A possible case of two Onodi cells in a single patient.
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