Smoking cessation in chronic Reinke's oedema.

In evaluating the long term results of surgical treatment of Reinke's oedema, there has been found to be a high incidence of recurrence. The recurrence rate is significantly lower amongst those patients who gave up smoking after treatment. A group of patients with chronic Reinke's oedema were followed for six months. Maximum efforts were made to help the patients to stop smoking. Twenty-nine patients entered the study, but only eight of them (28 per cent) refrained from smoking; all were women (39-70 years) and all experienced reduced discomfort, although none of the voices were restored to normal. Diffuse laryngitis disappeared completely, but the oedema did not disappear entirely in any patient. Before treatment of chronic Reinke's oedema patients must be well advised and informed, and if surgery is decided upon, they must be urged most strongly to stop smoking, if they wish to enhance the possibility of satisfactory long-term results.

Premalignant lesions of the larynx. A follow-up study.

The object of this investigation was to evaluate in the long-term the risk of malignancy occurring in the larynx of patients with dysplasia in the laryngeal epithelium. Over an 8-year period, 1974-82, 170 patients underwent microlaryngoscopic examination of the larynx including biopsy, showing hyperplasia and/or keratosis with or without dysplasia in the laryngeal epithelium. Of these, 147 patients were examined, on an average, 5 years and 4 months later. All histological specimens were reviewed by the same pathologist. Of the patients initially showing mild dysplasia, 7.8% developed aggravation while 55.6% of the patients displaying moderate dysplasia had developed severe dysplasia or carcinoma. 93.2% were smokers. It is concluded that all patients with atypia in the laryngeal epithelium should be observed at regular intervals, but special attention should be given to patients showing moderate dysplasia or worse.

Topical treatment of Reinke's oedema with beclomethasone dipropionate (BDP) inhalation aerosol.

Reinke's oedema is a disease which is characterized by oedema of the vocal cords. Women in middle age are particularly prone to this disease, which is encountered mostly in habitual smokers and is often connected with vocal abuse. The condition gives rise to a deep hoarse voice. The traditional treatment is decortication of the vocal cords followed by speech therapy, but the results have so far been disappointing. It has been shown by Moesgaard Nielsen et al. (1985) and Matsuo et al. (1983) that, in the long term, the incidence of recurrence is approximately 60 per cent. Medical treatment of this disease is therefore desirable. It is widely known that topical steroids are often used, but the effects of such treatment have not, so far as we know, been documented. We have found it interesting to observe the effects of BDP inhalation aerosol and placebo in the course of a four-week double-blind randomized trial treatment of Reinke's oedema.

Reinke's oedema: a premalignant condition?

The purpose of this investigation was to evaluate in the long term the risk of malignancy occurring in the larynx of patients treated for Reinke's oedema. Out of 120 patients treated by surgical stripping of the vocal cords during an eight-year period, 103 comprised the follow-up investigation group. Histological examination of the specimens from the stripping disclosed epithelial microscopic lesions in 26 per cent graded as not more than moderately dysplastic. At the follow-up examination 1 patient had developed cancer, while only 12 per cent still had epithelial lesions graded as not more than mildly dysplastic. The vast majority of the patients in this study were habitual smokers. We consider that patients with Reinke's oedema are likely to be in a higher risk group, and that this risk may be connected more with the smoking habit than the Reinke oedema itself.

Orbital floor fractures: early repair and results.

In the 5-year period 1978-1982, 34 patients with facial fractures underwent repair of the orbital floor. Reconstruction of the orbital floor by means of an implant was used in 28 of 34 patients (82%). Nineteen patients (56%) had a balloon inflated in the maxillary sinus to stabilize the orbital floor. Radiographic contrast solution was used in the balloon to facilitate the postoperative radiographic control of the balloon and the orbital floor. It was possible to make a follow-up study of 30 of the 34 patients. Nine of the patients had persisting reduced sensitivity in the infraorbital nerve region and 7 patients had slight enophthalmos. Out of the 30 patients, only 2 patients had persisting diplopia of a slight to moderate degree and none found it disturbing enough to need further surgery. This series shows that good results can be expected after early surgery and active management with open reposition, reconstruction and placing of an intral balloon are recommended.

Surgical treatment of Reinke's oedema (long-term results).

The purpose of this investigation was to evaluate the extent to which voice quality recovers and is retained in the long term, and the incidence of recurrence of Reinke's oedema, in patients treated by stripping of the vocal cords. Of 120 patients treated consecutively over an eight-year period, 111 comprised the follow-up investigation group. Only 19 per cent had a normal voice. The remaining 81 per cent had voice problems, and of these, 68 per cent displayed obvious hoarseness, with recurrence of Reinke's oedema in 58 per cent. It is concluded that the long term curative effect of this traditional treatment is over-estimated, and that the elimination of various etiological factors, particularly habitual tobacco smoking and voice abuse, is of prime importance.

Thyroid hormone autoantibodies in a case of Hashimoto's disease.

A case of Hashimoto's disease is reported. The serum contained antibodies binding T3 and T4. The binding capacity and affinity constants for T3 were 0.03 mumol/l and 3.4 x 10(9) l/mol and for T4 0.3 mumol/l and 1.4 x 10(9) l/mol, respectively. After total thyroid lobectomy on the left and subtotal on the right the autoantibodies disappeared from the serum. Thyroid tissue from the patient proved to contain an antithyroglobulin. According to the findings, the T3- and T4-binding antibodies are directed against thyroglobulin. It is of clinical importance to bear these autoantibodies in mind as possible errors in measuring T3 and T4 by radioimmunoassay (RIA). If RIA determination gives unexpectedly high or low T3 and/or T4 values, testing of non-specific binding is recommended.