Reinke's oedema and thyroid function: a prospective study in 43 patients

Reinke's Edema

Reinke's edema (RE) is the polypoid degeneration of one or both vocal folds within Reinke's space. The viscoelastic properties of the mucosal folds are characteristically altered by the expansion of the subepithelial space. Most frequently, patients present with dysphonia, with women being more affected than men. The primary risk factor is tobacco use. Voice overuse and laryngopharyngeal reflux are also considered to be contributory. Although RE shares the same primary risk factor as malignancy, the risk of malignancy is low, and dysplasia is found only in 0% to 3% of cases. Treatment is focused on decrease of risk factors, such as implementation of smoking cessation, voice therapy, and reflux control. Surgical techniques aim to decrease redundant polypoid mucosa in order to improve voice and restore the glottic airway. Recurrence of RE is high.

Langzeitergebnisse nach mikrolaryngoskopischer Abtragung von Reinke-Ödemen

BACKGROUND

In the case of Reinke's edema, the usual aim of microlaryngoscopic vocal fold stripping is an improvement of voice quality. Long-term results concerning functional voice quality in the literature vary widely. Whether and to what degree surgical intervention leads to the desired postoperative results is therefore still an open question. Therefore we conducted a follow-up study to review our own treatment results.

MATERIALS AND METHODS

We questioned 88 patients treated for Reinke's edema, either orally or by means of a written questionnaire, 6 months to 7 years (mean: 3.5 years) after the operation (longitudinal incision, removal of the edema by suction, resection of surplus vocal cord mucosa), asking about postoperative voice quality and subjective impression of how successful the operation had been. In all 63 patients answered the questionnaire; 16 agreed to undergo follow-up laryngostroboscopy.

RESULTS

51 patients (81%) reported a postoperative improvement in voice quality, 8 patients (13%) rated their voice quality as unchanged, and 4 patients (6%) complained of deterioration in their voice quality. Among the patients whose voices were subject to professional strain (n=27) a lower proportion experienced successful results (voice quality improved: 71%; unchanged: 21%; worse: 8%) than among patients without vocal strain (n=36; improved: 86%; unchanged: 11%; worse: 3%). Postoperative elimination or restriction of such etiological factors as smoking and vocal strain also improved the long-term results. Follow-up examination in 16 patients revealed a good correlation between the patients' subjective reports and the stroboscopic and auditory findings.

CONCLUSION

Patients should be selected very carefully for surgical treatment of Reinke's edema. The elimination of etiological factors is of highly significant in terms of the prognosis. Before surgery patients should be fully informed of how uncertain the prognosis is.

A Clinico-pathological study of Reinke'S oedema

An analysis of 92 eases of Reinke's oedema was done in this study. It wen most often seen in middle-aged persons. A Male predilection (57%) was found. In 68 (74%) cases, the lesions were unilateral and in 24 (26%) teses, the lesions were bilateral. Smoking (83%), vocal alms or misuse (80%) and chromnic respiratory tract infection (43%) were the main aetiological factors. No significant relationship of reinke's oedema with hypotkyroidsm was found. There were no dysplastic changes in the epithelium The treatment of reinke's oedema is a combination of surgery and vocal rehabilitation. Conventional microlaryngeal surgery is ideal for the treatment of Reinke's oedema. Acquired laryngeal web involving the anterior part of the vocal cords may develop if stripping of the both vocal cords is performed carelessly. Operating measures do not prevent recurrences of Reinke's oedema. Voice therapy and cessation of smoking in the postoperative period play important roles in the long term treatment results of Reinke's oedema.