Vocal fold mucosa that has been damaged by smoking and phonotrauma may react by producing excessive ECM, resulting in RO. Both epithelial and stromal cells are in a state of higher metabolic activity, indicating their role in this production.

Using morphological criteria we divided Reinke's oedema into a pale (transparent) and a livid type. The latter is more difficult to treat because of its prolonged postoperative recovery. Ten samples of pale Reinke's oedema and 10 of livid oedema were selected for cytological, histological and histochemical analysis in order to determine some of their fundamental characteristics and differences. Tissue samples were stained by hemalaun-eosin, Mallory-azan and Paf-Halmi method (specific for visualization of elastic versus collagen fibres). Cytology (May-Grünwald Giemsa) of cellular elements was undertaken by imprint method of the excised oedematous tissue. Also, the silver-staining nuclear organizer regions (Ag NOR) were identified and quantified. We identified intracytoplasmic granula and silver-staining nuclear organizing regions (Ag NOR) in stromal cells of pale type Reinke's oedema. Thus, it may be supposed that smoke irritation provokes higher activity of stromal cells producing a special substance in Reinke's space-resulting finally in Reinke's oedema.

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