Multiple laser puncture for Reinke’s edema: surgical outcome and voice assessment

Abstract

<p class="abstract"><strong>Background: </strong>The two important principles in Reinke’s edema treatment are minimal intervention and superficial resection with evacuation the edema and preservation the medial edge of the vocal fold to improve the voice quality. The aim of this study was to evaluate a novel surgical technique in treatment of Reinke’s edema and its effect on subjective and quantitative voice characteristics. The study design was a prospective clinical series.</p><p class="abstract"><strong>Methods: </strong>We evaluated 67 patients from 19 to 73 years (mean, 47.7 years) with Reinke’s edema. The patients were divided into 3 types, mild, moderate and sever. Clinical voice assessment was composed of stroboscopy, subjective voice evaluation (GRBAS hoarseness scale) and quantitative voice evaluation were evaluated pre- and postoperatively. All patients underwent endolaryngeal CO2 laser puncturing for treatment of Reinke’s edema.</p><p class="abstract"><strong>Results: </strong>67 patients diagnosed as Reinke’s edema were classified by H. Yonekawa classification into three types. Type I 25 (37.3%) patients, type II 30 (44.8%), type III 12 (17.9%). Out of 67 patients, fifty two (77.6%) were smoker. In all the patients, the laryngostrobscopic findings showed an improvement of mucosal wave patterns with little vocal fold scaring. Significant vocal improvement was also noted in subjective and objective voice assessments.</p><p class="abstract"><strong>Conclusions: </strong>The laser puncture technique is safe, effective and less invasive to treat Reinke’s edema with significant improvement in vocal performance after surgery.</p>

Reinke’s Edema

“…They defined Grade 1 edema as edema on the superficial side of the vocal folds, Grade 2 as edema radiating to the posterior aspect of the vocal folds, and Grade 3 as gross edema. 2,12,18 This system uses gross perceptual assessment and acoustic measurements based on lesion size to assess voice changes; however, the anatomical description of the lesion is incomplete. In addition, the scale is limited to the possibly obstructive presentation of the lesion and has not been validated.…”

“…Mechanical, pathological, chemical, genetic, smoking habits, vocal abuse , and gastroesophageal/laryngopharyngeal reflux have been identified as potential risk factors. 2 Grill et al identify altered pathways in plica vocalis fibroblasts isolated from ER tissue and to investigate the functional consequences of these changes. Long-term irritants and noxious agents such as smoking and heavy use of voices, gene expression in vocal cord fibroblasts in the ER is constantly changing, which may be epigenetically regulated and detectable in primary cell cultures of vocal cord fibroblasts.…”

“…These lesions may be unilateral or bilateral, sessile, swollen with fluid on the vocal cords, and very mobile during phonation. [1][2][3][4] RE is also known as smoking polyp, polypoid laryngitis, polypoid degeneration, and chronic hypertrophic laryngitis. 1.5 It is reported that the prevalence of RE in the general population is less than 1%.…”