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Quinton BA, Arianpour K, Yaffe NM, Tierney WS, Benninger MS, Bryson PC. Reassessing the Role of Phonomicrosurgery and Smoking Status in the Management of Reinke's Edema. Laryngoscope 2024; 134:2659-2663. [PMID: 38009572 DOI: 10.1002/lary.31207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To elucidate recurrence patterns of Reinke's edema (RE) following phonomicrosurgery and compare current and former smokers' outcomes. METHODS A retrospective chart review was performed for patients who underwent microflap excision for RE at our institution since 2008. Patient data were collected, including demographics, smoking history, and operative and voice outcomes during the available follow-up period. Descriptive statistics, student's t-tests, Chi-squared analyses, and Fischer's exact tests were used for the appropriate between-group comparisons utilizing JMP statistical software. RESULTS Patients who quit smoking on the day of surgery or continued to smoke postoperatively were included in our group of current smokers (n = 56). Patients who quit smoking within the month of surgery or longer were included in our group of former smokers (n = 22). There was no significant difference in postoperative voice outcomes between groups. Eight patients in the entire cohort experienced recurrence during the available follow-up period. Fischer's exact test revealed no statistically significant association between smoking status and recurrence (two-tailed p > 0.05). The mean time to recurrence for current smokers who did recur was 69 and 54 months for former smokers. CONCLUSION We report low overall recurrence rates after microflap excision of RE lesions compared with historical data, without any significant difference in recurrence or voice outcomes when comparing current and former smokers. Further prospective trials with larger sample sizes are warranted to guide the surgical management of RE patients and the implications of smoking status. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2659-2663, 2024.
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Affiliation(s)
- Brooke A Quinton
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Noah M Yaffe
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - William S Tierney
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Paul C Bryson
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, USA
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Longo L, Pipitone LL, Cilfone A, Gobbi L, Mariani L. Reinke's Edema: New Insights into Voice Analysis, a Retrospective Study. J Voice 2023:S0892-1997(23)00249-7. [PMID: 37716890 DOI: 10.1016/j.jvoice.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Reinke's edema (RE) is a pathological condition involving increased volume of the vocal folds and resulting in significant impact on speech, fundamental frequency, and vocal range. Literature reports few studies which analyze vocal features according to the severity of RE. The aims of this study were to investigate the aerodynamics, acoustic characteristics, and sound spectrograms of a group of RE patients and to assess whether there was any correlation with their endoscopic grading. METHODS A total of 98 patients were included in the study, 49 patients with RE and 49 healthy volunteers (HV). Multidimensional Voice Program was used to perform objective voice assessment. Maximum phonation time (MPT) and Voice Handicap Index (VHI) questionnaire were collected. The spectrograms of the vowel /a/ and of the word /aiuole/, which contains the five Italian vowels, of each patient were analyzed according to the classification of Yanaghiara modified by Ricci Maccarini and De Colle. Laryngological assessment was used to record vocal folds morphology according to Yonekawa's classification. Univariate analysis was used to compare group outcomes. Bivariate analysis was used to compare endoscopic grading and voice analysis results. RESULTS Univariate analysis of the HV and RE groups revealed statistically significant differences (P < 0.05) for the following parameters: jitter%, shimmer%, harmonic-to-noise ratio (NHR), voice turbulence index (VTI), MPT, VHI except for soft phonation index. Spearman's rank correlation showed a positive correlation between vocal parameters such as jitter%, shimmer%, NHR, VTI, and RE gradings. A negative correlation was found between MPT and RE gradings. Bivariate analysis indicated a strong positive correlation between RE grading and the spectrogram classification performed both with the vowel / a / (Rho 0.86; P = 0.0001) and with the word / aiuole / (Rho 0.81; P = 0.0001). CONCLUSION The present study demonstrates that patients with RE have different voice characteristics compared to HV. In particular, the voice analysis highlighted acoustic parameters that correlated to differing degrees of RE. In addition, spectrogram analysis should be considered for acoustic assessments before and after medical and surgical therapy and also in forensic medicine.
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Affiliation(s)
- Lucia Longo
- Department of Sense Organs, Sapienza University, Rome, Italy
| | | | - Armando Cilfone
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Luca Gobbi
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Laura Mariani
- Department of Sense Organs, Sapienza University, Rome, Italy
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Lou X, Lou Z. Reinke's Edema: Cold Steel Versus Radiofrequency Coblation. EAR, NOSE & THROAT JOURNAL 2023:1455613231194131. [PMID: 37596878 DOI: 10.1177/01455613231194131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023] Open
Abstract
OBJECTIVE This study compared the effects of radiofrequency (RF) coblation and cold steel (CS) surgery for the treatment of Reinke's edema (RE). METHODS A retrospective analysis was conducted on 61 patients with RE, with 33 (54.1%) in the CS surgery group and 28 (45.9%) in the RF coblation group. The primary endpoints were the bilateral operation time and dyspnea severity, assessed preoperatively and at 1 and 3 months postoperatively. Secondary endpoints included subjective and objective vocal assessments, laryngovideostroboscopy (LVS) images, and Voice Handicap Index-10 (VHI-10) scores obtained before and at 1 and 3 months postoperatively. RESULTS The average bilateral operation time was significantly shorter in the RF coblation group (24.2 ± 3.9 min) compared to the CS group (38.4 ± 5.2 min) (P = .041). All patients experienced a decrease in their Dyspnea Severity Index (DSI) scores postoperatively, with no significant differences observed between the two groups at any time point. However, improvements in the grade of hoarseness, roughness, and asthenia were significantly greater in the RF coblation group than in the CS group (P < .001). There were no statistically significant differences in breathiness and strain between the two groups. The average VHI-10 score significantly decreased from preoperative values in both groups (P < .001), with no significant differences observed between the two groups at any time point. CONCLUSIONS The RF coblation procedure is a reliable and safe method for RE surgery, offering an effective treatment choice for RE.
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Affiliation(s)
- Xudan Lou
- Department of Operating Theater, Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
| | - Zhengcai Lou
- Department of Otolaryngology-Head and Neck Surgery, Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
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Hamdan AL, Abi Zeid Daou C, Ghanem A, Ar Feghali P, Hosri J, Sataloff RT. Office-based Laser Therapy in Reinke's Edema: A Systematic Review and Meta-analysis. J Voice 2023:S0892-1997(22)00392-7. [PMID: 36681567 DOI: 10.1016/j.jvoice.2022.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To analyze voice outcomes and lesion regression in patients with Reinke's edema treated in the office with lasers. STUDY DESIGN Systematic review and meta-analysis METHODS: The search was performed in the Medline, Embase, Medline, Cochrane, and Google Scholar databases using the PRISMA framework. There were no limitations to the year of publication and the search included studies looking at voice outcomes and lesion evolution of in-office laser treatment for Reinke's edema measured through voice-handicap index, acoustic analysis or aerodynamics measures. Risk of bias was assessed using Cochrane's ROBINS-I tool for observational studies. Data analysis was performed SPSS software with a significance level of 5%. RESULTS The initial search identified 650 articles, 6 of which met the inclusion criteria and were analyzed. The total number of participants was 58. Meta-analysis showed significant improvement in VHI-10 scores after in-office laser therapy (95% CI, [-1.46; -0.75]). It also showed significant improvement in jitter, significant increase in fundamental frequency (95% CI, [0.52; 1.71]) and significant decrease in lesion size (95% CI, [-2.03; -0.35]). CONCLUSION Office-based laser therapy is a reliable alternative to the traditional phono-microsurgery performed in the operating room. Patients show significant improvement in voice outcomes and laryngeal examination.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research..
| | - Christophe Abi Zeid Daou
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research
| | - Anthony Ghanem
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research
| | - Patrick Ar Feghali
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research
| | - Jad Hosri
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research
| | - Robert T Sataloff
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut, Beirut, Lebanon; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine; Lankenau Institute for Medical Research
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Dewan K, Chhetri DK, Hoffman H. Reinke's edema management and voice outcomes. Laryngoscope Investig Otolaryngol 2022; 7:1042-1050. [PMID: 36000026 PMCID: PMC9392404 DOI: 10.1002/lio2.840] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Reinke's edema is a chronic disease of the respiratory tract that occurs in adults with a history of chronic smoke exposure. Also known as polypoid corditis, polypoid laryngitis, and polypoid degeneration of the vocal fold, it is strongly associated with smoking, frequently with vocal misuse/abuse, and occasionally with laryngopharyngeal reflux. Reinke's edema remains a cause of chronic dysphonia that is difficult to manage. This review provides perspectives on current and future management of Reinke's edema. Results Reinke's edema impacts <1% of the population. The excessive mass is seen in polypoid degeneration results in a loss of pitch control and a rough voice. Women are more likely to present for treatment as the characteristic lowering of vocal pitch is more noticeable in women than men. Multiple grading systems have been proposed within the literature. The current standard of care is surgical excision, after smoking cessation. The microflap technique remains the approach of choice for bulky lesions. Surgical management of Reinke's edema has evolved with the introduction of various lasers into otolaryngologic practice; some which can now be used in the office setting. While many management approaches have been described within the literature, there is a little direct comparison and no obvious superior method of Reinke's edema management. Conclusion To date, the biology of Reinke's edema is not well understood. Additional research is needed further elucidate the role of uncontrolled reflux in the development and recurrence of Reinke's edema.
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Affiliation(s)
- Karuna Dewan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Dinesh K. Chhetri
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCaliforniaUSA
| | - Henry Hoffman
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
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Grigaliute E, Fiamingo MN, Albanese PG, La Mantia I. Phonosurgery of Reinke's edema with microdebrider. Eur Arch Otorhinolaryngol 2022; 279:4053-4059. [PMID: 35403885 PMCID: PMC9249694 DOI: 10.1007/s00405-022-07377-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/25/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE To present our experience with a new microsurgical approach for treatment of the Reinke's edema in suspension laryngoscopy-microdebridement. After a short review of existing literature we introduce speech therapy before and after the surgery into the protocol. METHODS The authors compare the phonatory outcome, laryngostroboscopical results and subjective improvement of the voice of 30 patients with Reinke's edema that were operated with either microdebridement or cold steel surgery techniques. "Sandwich" speech therapy strategy was applied for the vocal rehabilitation before and after surgery in both patient groups. RESULTS After the microdebridement and the speech therapy the mucosal wave was regular, symmetric and periodic in all patients. No signs of abnormal scar tissue or anterior adhesions were observed. Significant improvement of vocal parameters was found after the surgery in both groups of patients: operated with the microdebridement technique and the cold steel technique. The subjective voice evaluated by Voice Handicap Index (VHI-10) was improved for both patient groups in a homogenous way. CONCLUSIONS Based on the similarity of the vocal outcome in the two groups, microdebridement of the vocal folds is an excellent method for removing the edema of the Reinke's space. Careful suction at a low voltage protects the lamina propria during the microdebridement. The authors discuss the indication to this innovating procedure in patients with difficult laryngeal exposure and small operating field.
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Affiliation(s)
- Egle Grigaliute
- Department of Otorhinolaryngology, University of Catania, Via S.Sofia 14, 95125, Catania, Italy.
| | - Maria Novella Fiamingo
- Department of Otorhinolaryngology, University of Catania, Via S.Sofia 14, 95125, Catania, Italy
| | | | - Ignazio La Mantia
- Department of Otorhinolaryngology, University of Catania, Via S.Sofia 14, 95125, Catania, Italy
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de Vincentiis M, Ralli M, Cialente F, Greco A, Marcotullio D, Minni A, Kim SH, Remacle M. Reinke's edema: a proposal for a classification based on morphological characteristics. Eur Arch Otorhinolaryngol 2020; 277:2279-2283. [PMID: 32285193 DOI: 10.1007/s00405-020-05934-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Reinke's edema is a benign laryngeal condition characterized by swelling of the superficial layer of the lamina propria of the vocal fold. The aim of this work is to propose a new classification of Reinke's edema based on its morphological characteristics. METHODS Our classification is a synthesis of the classifications available in the literature and is based on morphological characteristics such as the involvement of one or two vocal folds and the presence or absence of polypoid lesions regardless of the observation method. RESULTS We indicate four types of Reinke's edema: type 1: Reinke's edema of one vocal fold; type 2: Reinke's edema of both vocal folds; type 3: Reinke's edema of one vocal fold with associated polypoid lesion, not necessarily the same fold of the edema; type 4: Reinke's edema of both vocal folds with associated polypoid lesion on one or both folds. CONCLUSION Our proposed classification for Reinke's edema represents a synthesis of the classifications available in the literature and is characterized by a simple categorization based on morphological characteristics commonly visible through laryngoscopy.
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Affiliation(s)
- Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 33, 00168, Rome, Italy.
| | - Fabrizio Cialente
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 33, 00168, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 33, 00168, Rome, Italy
| | - Dario Marcotullio
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 33, 00168, Rome, Italy
| | - Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 33, 00168, Rome, Italy
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Marc Remacle
- Department of Otorhinolaryngology and Head and Neck Surgery, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg
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Umeno H, Hyodo M, Haji T, Hara H, Imaizumi M, Ishige M, Kumada M, Makiyama K, Nishizawa N, Saito K, Shiromoto O, Suehiro A, Takahashi G, Tateya I, Tsunoda K, Shiotani A, Omori K. A summary of the Clinical Practice Guideline for the Diagnosis and Management of Voice Disorders, 2018 in Japan. Auris Nasus Larynx 2020; 47:7-17. [DOI: 10.1016/j.anl.2019.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 12/01/2022]
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Khodeir MS, Hassan SM, El Shoubary AM, Saad MNA. Surgical and Nonsurgical Lines of Treatment of Reinke's Edema: A Systematic Literature Review. J Voice 2019; 35:502.e1-502.e11. [PMID: 31761692 DOI: 10.1016/j.jvoice.2019.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aim of this study was to carry out a systematic review of different surgical and nonsurgical lines of treatment of Reinke's edema to identify the effectiveness and the guidelines described to use each of them. METHODS We searched PubMed and Coherence for randomized controlled trials and case reports studies did on adult humans aged from 18 to 80 years, from January 1997 to December 2018. We included studies that treated patients with Reinke's edema by one and/or combinations of the following interventions: cold steel microlaryngeal phonosurgery, microdebrider, CO2 laser, photoangiolytic laser, voice therapy, Steroid and Hyaluronidase injection. We selected studies that assessed patients pre- and post-treatment by at least one of the following measures: subjective assessment of the patient's voice by the voice handicap index, perceptual analysis of the voice by GRBAS scale, video laryngeoscopic examination of the VFs and the lesion, aerodynamic measures, and acoustic analysis of the voice by the computerized speech lab. We assessed quality of the included studies with the Cochrane risk of bias assessment Tool. RESULTS After removal of duplicates, research yielded 262 studies. Of 217 abstracts and titles, 36 full-text articles were read, and one study was added through hand search, resulting in 10 included studies. CONCLUSIONS Most of literature analyzed were deficient to address the effectiveness of any of the six lines included in this study. This is mainly due to the small number of the included articles and the small sample size in most of these studies. We found only 10 articles that reported the effectiveness based on comparing the results of before and after treatment. In addition, the variability of outcome measures used and the lack of the comprehensive assessment of the patient's voice, vocal image in most of the included studies made it hard to us to compare the results of any of the included studies. More researches with larger sample size and accurate randomization are needed for further accurate assessment of the effectiveness of the surgical and nonsurgical lines of treatment of Reinke's edema. The future researches should take in their consideration the use of an agreed comprehensive assessment protocol for assessing and comparing the outcome measures before and after treatment.
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Affiliation(s)
- Mona Sameeh Khodeir
- Unit of Phoniatrics, Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt.
| | - Sabah Mohamed Hassan
- Unit of Phoniatrics, Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt.
| | - Aleyia Mahmoud El Shoubary
- Unit of Phoniatrics, Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt.
| | - Mira Nabil Abdo Saad
- Unit of Phoniatrics, Otorhinolaryngology Department, Manshyeit El-Bakry Hospital, Cairo, Egypt.
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Schyberg YM, Bork KH, Sørensen MK, Rasmussen N. “Cold-Steel” Phonosurgery of Reinke Edema Evaluated by the Multidimensional Voice Program. J Voice 2018; 32:244-248. [DOI: 10.1016/j.jvoice.2017.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Rzepakowska A, Sielska-Badurek E, Cruz R, Sobol M, Osuch-Wójcikiewicz E, Niemczyk K. Voice Profile Recovery and Quality of Life Changes After Microdirect Laryngoscopy in Three Categories of Glottis Lesions: Benign, Precancerous, and Malignant. J Voice 2017; 33:382.e11-382.e20. [PMID: 29198815 DOI: 10.1016/j.jvoice.2017.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/18/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
The aim of the study was comparison of voice and life quality after microdirect laryngoscopy in three patient histopathological categories: benign, precancerous, and malignant glottic lesions. A totalnof 137 patients treated with microdirect laryngoscopy were included in the study. Each patient was evaluated with a multidimensional protocol before and 3, 6, and 12 months after treatment. Final 1-year evaluations were achieved in 74.5% (102). The assessment included laryngovideostroboscopy (LVS), perceptual (GRBAS) grading, aerodynamic measures including maximum phonation time and phonation quotient and acoustic measurements (Kay Elemetrics Multi-Speech program), Voice Handicap Index (VHI), Voice-Related Quality of Life questionnaire; and World Health Organization Quality of Life Scale-Brief Version (WHOQoL-BREF). An improvement in mean value of LVS ratings was obtained in all three groups; however, only in benign lesion group was it consistently statistically significant for each time period (P < 0.001). Perceptual evaluation revealed significant improvement of G, R, and B parameters in benign lesions for each time period. In malignant neoplasms R and B parameters improved 3 and 6 months post microsurgery. In patients with benign lesions the maximum phonation time increased, but the improvement was significant only after 3 months. The acoustic parameters improved in all three groups. VHI significantly improved in patients with benign lesions after 3 and 12 months. VHI in the malignant neoplasm group significantly worsened on the first follow-up visit. Considering quality of life (QoL) results, only in patients with benign lesions was there a significant improvement in overall assessment of their QoL and general health.
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Affiliation(s)
- Anna Rzepakowska
- Otolaryngology Department, Warsaw Medical University, Warsaw, Poland.
| | | | - Raul Cruz
- Otolaryngology Department, Kaiser Permanente Medical Center, Oakland, United States
| | - Maria Sobol
- Biophysics and Human Physiology Department, Warsaw Medical University, Warsaw, Poland
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Martins RHG, Tavares ELM, Pessin ABB. Are Vocal Alterations Caused by Smoking in Reinke's Edema in Women Entirely Reversible After Microsurgery and Smoking Cessation? J Voice 2016; 31:380.e11-380.e14. [PMID: 27452718 DOI: 10.1016/j.jvoice.2016.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/17/2016] [Accepted: 06/23/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Reinke's edema is a benign lesion of the vocal folds that affects chronic smokers, especially women. The voice becomes hoarse and virilized, and the treatment is microsurgery. However, even after surgery and smoking cessation, many patients remain with a deep and hoarse voice. OBJECTIVES The aim of the present study was to compare pre- and postoperative acoustic and perceptual-auditory vocal analyses of women with Reinke's edema and of women in the control group, who were non-smokers. METHODS A total of 20 women with videolaryngoscopy diagnosis of Reinke's edema who underwent laryngeal microsurgery were evaluated pre- and postoperatively (6 months) by videolaryngoscopy, acoustic voice, and perceptual-auditory analyses (General degree of dysphonia, Roughness, Breathiness, Asthenia, Strain, and Instability [GRBASI] scale), and the maximum phonation times were calculated. The pre- and postoperative parameters of the women with Reinke's edema were compared with those of the control group of women with no laryngeal lesions, smoking habit, or vocal symptoms. RESULTS Acoustic vocal perceptual-auditory analyses and the maximum phonation time of women with Reinke's edema improved significantly in the postoperative evaluations; nevertheless, 6 months after surgery, their voices became worse than the voices of the women from the control group. CONCLUSIONS Abnormalities caused by smoking in Reinke's edema in women are not fully reversible with surgery and smoking cessation. One explanation would be the presence of possible structural alterations in fibroblasts caused by the toxicity of cigarette components, resulting in the uncontrolled production of fibrous matrix in the lamina propria, and preventing complete vocal recovery.
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Affiliation(s)
| | - Elaine Lara Mendes Tavares
- Speech Therapy, Discipline of Otolaryngology, UNESP Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Adriana Bueno Benito Pessin
- Speech Therapy, Discipline of Otolaryngology, UNESP Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
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Abstract
Reinke edema is one of the common cause of dysphonia middle-aged population, and severe thickening of vocal folds require surgical treatment. Smoking plays a major role on etiology. Vocal fold cysts are also benign lesions and vocal trauma blamed for acquired cysts. We would like to present 3 cases with vocal fold cyst related with Reinke edema. First case had a subepidermal epidermoid cyst with Reinke edema, which could be easily observed before surgery during laryngostroboscopy. Second case had a mucous retention cyst into the edematous Reinke tissue, which was detected during surgical intervention, and third case had a epidermoid cyst that occurred 2 months after before microlaryngeal operation regarding Reinke edema reduction. These 3 cases revealed that surgical management of Reinke edema needs a careful dissection and close follow-up after surgery for presence of vocal fold cysts.
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