Reinke Edema: Factors that Interfere with Vocal Recovery after Surgery

Abstract Introduction Dysphonia and lower pitch after surgery of Reinke edema are common. They are caused especially due to chronic smoking but, probably, other factors should be associated. Objectives To evaluate the results of laryngeal microsurgery in patients with Reinke edema, following a standardized postoperative guidance protocol in our service. Methods Retrospective study. Thirty patients (3 males; 27 females) were included, 70% between 41 and 60 years old. The parameters analyzed in the pre- and postoperative (between 4 and 6 months) of patients undergoing laryngeal microsurgery for Reinke edema were: smoking, vocal symptoms, videolaryngostroboscopy, voice therapy, perceptual and acoustic vocal evaluation, histopathological report. Results Smoking was reported by 100% of the patients and maintained in the postoperative period by 80%. Complete improvement of symptoms in the postoperative period was reported by 43% of them, partial improvement by 40%, and maintenance by 17%. There was low adherence to voice therapy in the pre- and postsurgery. Postoperative videolaryngoscopy indicated congestion (19), atrophy and bowed vocal fold (1), subepithelial edema (2), and normal findings (8). The histological findings were subepithelial edema, enlargement of vessels, inflammation, epithelial hyperplasia, and thickening of the basement membrane. The perceptual and acoustic vocal analyzes indicated improvement of the analyzed parameters. Conclusions The maintenance of some vocal symptoms and laryngeal alterations in videolaryngoscopy after microsurgery of Reinke edema is frequent, even in patients who follow the recommendations of vocal rest and control of gastroesophageal reflux. Vocal symptoms are attributed to changes in the laryngeal mucosa caused by chronic smoking, aggravated by the maintenance of addiction in the postoperative period.

Profile of Laryngeal Microsurgeries in Patients Over 60 Years Old

Abstract Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associ- ated with laryngeal lesions and determine prevention and treatment approaches.

Edema de Reinke obstructivo / Obstructive Reinke edema

Introducción: el edema de Reinke es la acumulación de fluidos en la capa externa de la lámina propia de las cuerdas vocales. Produce disfonía y raras veces obstrucción respiratoria. Las etiologías más frecuentes son el tabaquismo, el reflujo gastroesofágico y el mal uso y abuso vocal. Objetivos: determinar, mediante tratamiento quirúrgico, la tasa de resolución de la disnea inspiratoria severa provocada por edema de Reinke bilateral de cuerdas vocales. Diseño: estudio descriptivo y retrospectivo. Material y métodos: revisión de las historias clínicas electrónicas de todos los pacientes que consultaron y fueron tratados por disnea inspiratoria severa provocada por edema de Reinke bilateral de las cuerdas vocales, en el servicio de Otorrinolaringología del Hospital Italiano de Buenos Aires, entre febrero de 2007 y abril de 2015. Resultados: fueron tratados 4 pacientes de sexo femenino que consultaron por disnea inspiratoria severa. Fumaban más de 30 cigarrillos por día. La técnica quirúrgica consistió en resecar todo el edema polipoideo en forma bilateral, preservando el borde libre de las cuerdas vocales. Conclusiones: el edema de Reinke obstructivo es una patología infrecuente. La tasa de resolución de la disnea inspiratoria severa en las cuatro enfermas tratadas fue del100%. La resección total del edema y de la mucosa excedente, preservando un pequeño sector para que recubra el borde libre de la cuerda vocal (cordectomía vs. cordotomía), fue la técnica quirúrgica preferida. (AU)

Introduction: the Reinke edema is an accumulation of fluid in the outer layer of the lamina propria of the vocal cords. Causes dysphonia and rarely produces respiratory obstruction. Objectives: to determine the rate of resolution of the severe inspiratory dyspnea caused by bilateral Reinke edema of vocal cords with surgical treatment. Design: descriptive and retrospective study. Material and methods: review of the electronic medical records of all patients who consulted and were treated for severe inspiratory dyspnea caused by bilateral Reinke edema of the vocal chords in the Hospital Italiano de Buenos Aires between February 2007 and April 2015. Results: four women were treated, consulted for severe inspiratory dyspnea. Smoked more than 30 cigarettes per day. The surgical technique consisted in to resect all the bilateral polypoid edema, while preserving the free edge of the vocal cords. Conclusions: the obstructive Reinke edema is an infrequent pathology. The rate of resolution of the severe inspiratory dyspnea in the four patients treated was 100%. The total resection of the edema and mucosa excess, preserving a small sector to cover the free edge of the vocal cord (cordectomy vs cordotomy) was the preferred surgical technique. (AU)

Acoustic Outcomes After Laryngomicrosurgery for Reinke's Edema

BACKGROUND AND OBJECTIVES: The management of Reinke's edema includes usually medical treatment and voice therapy. Laryngomicrosurgery (LMS) is also necessary, especially to improve airway obstruction. However, voice outcome after LMS has not been determined well. The aim of this study was to evaluate effectiveness of LMS for Reinke's edema and analyze the voice outcomes after LMS. MATERIALS AND METHODS: Twenty-five patients with Reinke's edema who underwent LMS from September 2007 to December 2016 were enrolled in this study. We analyzed reflux finding score (RFS), reflux symptom index (RSI), and acoustic parameters before and after surgery. RESULTS: Male was 15 (60%) and female was 10 (40%), and mean age was 49.6 years. Preoperative mean value of RFS decreased significantly up to 3 months after LMS (18.3±2.2 and 10.0±2.2 at preoperative and 3 months postoperatively, respectively). The mean value of Jitter decreased significantly before and after surgery (2.71±2.81% and 1.06±1.21% before and after LMS, p=0.041). The mean value of Shimmer also decreased significantly before and after surgery (7.97±3.63% and 4.83±1.85%, respectively, p=0.006). CONCLUSION: LMS is effective in the treatment of Reinke's edema. It results in favorable acoustic outcomes and laryngoscopic findings in properly selected patients.

Multiple Laryngeal Polyposis; A Newly Introduced Entity: Update.

Introduction: Vocal fold polyps are caused by inflammation caused by stress or irritation. Laryngeal polyp may be a single polyp or more than one polyp affecting one vocal fold or both folds, translucent to red raspberry colored mass. Materials and Methods: The study group consisted of 40 patients, 32 males and 8 females. The mean age of the patients was 33 years; with a range of 23-55 years, suffering primarily from long standing dysphonia and were diagnosed by an otolaryngologist (Flexible naso pharyngo laryngoscope after application of painless topical anesthesia and rigid endoscopy) and voice pathologist through videostroboscopic analysis. First group, 20 patients had reinke's edema. Second group, 12 patients had unilateral multiple vocal fold polyps. Third group, 8 patients had bilateral vocal fold polyps. Results: First group Reinke's edema produces a deep, husky sounding voice, it is most commonly caused by tobacco/smoke exposure, but may also be aggravated by gastric reflux, second group, unilateral multiple or diffuse vocal fold polyps caused by intense intermittent voice use/abuse and the third group, bilateral vocal fold polyps and we found that its main etiology is abuse of voice and negligence of medical consultation for long time that leads to more trauma and development of more polyps. Conclusion: Reinke's edema, unilateral or bilateral multiple vocal cord polyps are a group of benign pathology can be collectively known as multiple laryngeal polyposis. It is a newly mentioned terminology, introduced by authors to describe collectively a picture of appearance of more than one polyp affecting either one or both vocal folds or the picture of classic Rreinke's edema.

Airway management in a patient with Reinke's edema: A case report

Reinke's edema begins with a chronic diffuse edema on the surface of the lamina propria of the vocal folds. It frequently occurs in women, smokers, professional voice users, and in patients with gastroesophageal reflux disease. Herein, we report the case of a patient who experienced ventilation difficulties during general anesthesia using positive pressure mask ventilation.

Common Factors Associated with Severity of Reinke's Edema / 听力学及言语疾病杂志

Objective To explore the common influencing factors on the severity of Reinke's edema of the vo-cal cord and to analyze the factors of recurrence.Methods To analyze the relationships among the degrees and smoking,voice overuse,and laryngopharyngeal reflux for 85 patients with Reinke's edema of the vocal cord,and an-alyze the risk factors of recurrence.ResuIts 84.7% of the patients were male with the mean age of 51.35 years. There were statistical differences among smoking history of more than 25 years (P<0.001),laryngopharyngeal re-flux (P<0.01),and voice overuse (P<0.01).Follow ups lasted 1 year and 7 patients showed recurrence.ConcIu-sion Reinke's edema was related to long - term smoking and common in senior male patients.The degree of Reinke's edema was positive correlation with smoking,laryngopharyngeal reflux and voice overuse.The most impor-tant factor is smoking history of more than 25 years.The longer smoking history,the more severe Reinke's edema.

The Clinical Characteristics and Voice Analysis of Reinke's Edema / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reinke's edema is characterized by the swelling of the vocal folds, which is bilateral, and is found superficial to the vocal ligament, Reinke's space. However, the etiology of Reinke's edema is not well understood, and voice characteristics are still controvertial. The aim of this study was to evaluate the clinical characteristics of Reinke's edema, and to assess the voice qualities in patients with Reinke's edema before and after a laryngomicrosurgery. Furthermore, this study also determined which parameters were most associated with the improvement of postoperative voice quality in Reinke's edema. SUBJECTS AND METHOD: The clinical records from 61 patients with Reinke's edema were reviewed and telephone questionnaires were carried out about smoking, laryngopharyngeal reflux, voice abuse, and allergy. All the patients were classified according to the stroboscopic findings (Yonekawa's classification). The voice analysis of 61 patients with Reinke's edema were performed and compared with 30 normal controls. Also, the voice analysis of 23 patients, who underwent laryngomicrosurgery, was carried out 2 months after surgery. RESULTS: Smoking, voice abuse and laryngopharyngeal reflux may play important roles in developing Reinke's edema. There were 26, 22, and 13 patients identified as Yonekawa types I, II, and III, respectively. The preoperative voice analysis of 61 patients showed decreased FxM (mean fundamental frequency), and increased subglottic pressure. Furthermore, FxSD (fundamental frequency standard deviation), QxM (mean closed quotient), and QxSD (closed quotient standard deviation) were all higher for the patients than the normal group. The postoperative results showed an increase in the FxM and an improvement in the MFR (mean flow rate), Psub (subglottic pressure), shimmer, and HNR (harmonics to noise ratio). The correlation analysis showed that jitter, HNR, QxM, and CFx (% irregularity of frequency) were the parameters, showing the best correlation with improvement in the postoperative voice quality. CONCLUSION: The fundamental frequency was approximated to normal ranges, and stabilizing of vocal fold vibration, and the improvement of vocal efficiency was also found 2 months after layngomicrosurgery. The parameters which represented voice quality by correlation analysis after surgery were jitter, HNR, QxM, and CFx.

The Phonetic Characteristics in the Types of Reinke's Edema / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reinke's edema has shown different voice qualities and different mucosal waves according to the degree of swelling in the vocal folds. The subjects were classified into three types : waterish, mixed, and gelatinous type according to the consistency of fluid in the Reinke's space. We compared voice parameters of different types of Reinke's edema. MATERIALS AND METHODS: All of the subjects were classified according to the laryngoscopic findings and operation findings. History for duration of disease, smoking histories, and the severity of laryngopharyngeal reflux were evaluated. Stroboscopy and videokymography were used for the assessment of mucosal waves. Voice parameters were obtained and compared from all subjects to assess acoustic and aerodynamic factors. RESULTS: Vocal fold vibrations of waterish type was more active than the gelatinous type or mixed type in the stroboscopic findings and videokymography. The fundamental frequency of gelatinous type was significantly lower compared to other types: however, subglottic pressure was significantly higher compared to other types. CONCLUSIONS: Reinke's edema was classified according to the gelatinous type, mixed type and waterish type according to the consistency of fluid in the vocal folds. There were typically acoustic and stroboscopic findings in each type.

Phonomicrosurgery for Reinke's Edema of the Vocal Fold / 中国微创外科杂志

0.05).The jitter(q=27.885),shimmer(q=35.839),NNE(q=5.817),and harmonic noise ratio(HNR,q=6.383)decreased significantly at 1 month after the operation(P

Videostrobokymographic Analysis of Reinke's Edema / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Videostrobokymography (VSK) has been recently developed in our institute. VSK can select multiple regions of interest and analyze vibratory patterns of vocal folds using video data recorded by the conventional videostroboscopy. But the efficacy of VSK in clinical application needs to be proven. MATERIALS AND METHODS: We compared the preoperative and postoperative VSK patterns of Reinke's edema in 15 cases with some other parameters. RESULTS: Most of the patients showed improvement of voice quality by self-assessment, however, the fundamental frequency and subglottic pressure did not return to the normal range after operation. Preoperative videostroboscopy for Reinke's edema patients revealed greatly irregular patterns of mucosal wave so that kymogram could be obtained only in 3 of the 8 preoperative examinations. However, postoperative vibration of the vocal folds returned to the regular pattern on VSK. CONCLUSION: VSK could serve as one of the effective tools to document the vocal fold vibration objectively in various kinds of benign mucosal diseases of the vocal folds.

Voice Analysis in Reinke's Edema / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reinke's edema is defined as swelling confined to the space underneath the epithelial layer known as Reinke's space. Patients suffering from Reinke's edema are known to have abnormally low fundamental frequency and high subglottic pressure. We compared the preoperative and postoperative voice results of Reinke's edema to evaluate quantitative changes of vocal function. MATERIALS AND METHODS: The voice analyses of 15 patients, who were diagnosed with Reinke's edema from 1997 January to 1998 September in Seoul National University Hospital, and 15 normal controls were undertaken with Multi-dimensional voice program (MDVP) and Aerophone II of Kay system. Eight preoperative patients, 13 postoperative patients, and 6 preoperative and postoperative patients were analyzed with respect to fundamental frequency (F0), pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), noise-to-harmonic ratio (NHR), subglottic pressure (Psg), mean vocal efficiency, mean flow rate (MFR), maximum phonation time (MPT), and contact quotient (CQ). Using videostrobokymography, vibratory patterns of vocal folds were analyzed. RESULTS: The fundamental frequency was lower than the normal preoperative and postoperative values. The PPQ, APQ, and NHR were decreased to the normal value after operation. The subglottic pressure, although elevated preoperatively and decreased postoperatively, remained high. The mean vocal efficiency was increased to average value of normal controls after operation. The MFR, MPT, and CQ were not correlated with the course of Reinke's edema. The vocal folds vibration returned to regular pattern after operation on videostrobokymography. CONCLUSION: The fundamental frequency and subglottic pressure are not normalized after operation, and the PPQ, APQ, and NHR are good parameters of postoperative voice results. The voice therapy might help to correct the vocal habit of voice abuse and prevent recurrence after operation.