Reinke's Edema Research Articles

Die anatomischen Merkmale des Reinke-Raumes und die Ätio-Pathogenese des Reinke-Ödems*

On the basis of histological examination of normal human larynges, the authors have defined the anatomical and histological features of Reinke's space. It is sharply demarcated by dense fibrous tissue in the anterior commissure, along the vocal process of the arytenoid and beneath the free margin of the vocal cord. The upper limit is not always sharply demarcated, and on the upper surface Reinke's space varies considerably in size. It may include a half of the upper surface of the vocal cord, reaching usually to the bottom of the laryngeal ventricle and occasionally extending to include also the inferior surface of the ventricular fold. The authors suggest that the upper boundary of Reinke's space is functional. On the basis of the morphologic structure of Reinke's space a hypothesis of aetiopathogenesis of Reinke's oedema was set up. The patient's attempt to compensate the hoarseness by the use of the false vocal cords forces the fluid within Reinke's space towards the free edge of the vocal cord.

Laryngeal pathologies observed in microlaryngoscopy.

A retrospective analysis of 738 consecutive microlaryngoscopic procedures, performed in 655 patients at the Geneva Clinic of Otolaryngology, Head and Neck Surgery between 1981 and 1987, was undertaken. The 4 most frequent laryngeal pathologies were polyps, hyperplastic chronic laryngitis, Reinke's edema and laryngeal cancer accounting for 76.6% of all encountered pathologies. Of the sample studied, pathologies occurred more frequently in males than in females; however, certain pathologies were more common to one sex than to the other. In 15.3% of patients with benign lesions, multiple, coexisting laryngeal diseases were detected. In some instances, microlaryngoscopic and histological diagnoses were discordant.

喫煙と慢性喉頭炎

Relationships between tobacco smoking and chronic laryngitis were investigated in 11,809 adults who received physical check-ups for laryngeal cancer at the Yokohama Municipal Cancer Detection Center. The majority of examinees were in their forties or older. The subjects were divided into three groups relative to smoking : non-smokers, smokers with a smoking index (SI) of less than 400 and smokers with SI of 400 or greater. SI was defined as the number of cigaretts per day multiplied by the duration of smoking in year. Of the 11,809 subjects, 5,888 were male and 5921 were female. One thousand five hundred and eleven males and 4,752 females were non-smokers, 1,125 males and 798 females were smokers with SI of less than 400, and 3,252 males and 371 females were smokers with SI of 400 or greater. Attention was focused on the incidence of chronic laryngitis, vocal fold polyp, Reinke's edema, leukoplakia and cancer. The pathologies were observed in 22 percent of the male and 7 percent of the female non-smokers, 37 percent of the male and 34 percent of the female smokers with SI of less than 400, and 51 percent of the male and 54 percent of the female smokers with SI of 400 or greater. The majority of the pathologies was chronic laryngitis in each group.

DETECTION RATE OF LARYNGEAL CANCER IN A THOROUGH MEDICAL CHECK UP PERFORMED BY ALL JAPAN NATIONAL HEALTH INSURANCE ASSOCIATION OF ENGINEERING & CONSTRUCTION

In a through medical check up of engineering & construction and ordinary workers, 2702 and 110 people respectively, laryngeal fiberscopy was performed for 97 suspicious cases that were picked up by indirect laryngoscopy. Endoscopically guided biopsies were emploved to some of those cases.Glottic abnormalities were found in 53 cases of 97 suspicious people, namely 1.9% of all examined.Those 53 cases were 5 cases of laryngeal carcinoma (T1), 4 of either Keratosis, Papilloma or benign squamous hyperplasia, 12 of vocal cord polyp, 2 of vocal cord haematoma, 12 of chorditis, 7 of Reinke's edema and 3 of others. Each percentage was 0.18%, 0.14%, 0.43%, 0.07%, 0.43%, 0.25% & 0.11% respectively.All but one of chorditis and Reinke's edema belong to engineering & construction group.As for 1248 males over 50 year-old belonging to engineering & construction workers, the detection rate of laryngeal cancer was as high as 0.4% and about same rate reported in references of people with hoarseness.Accordingly, the way of life in the engineering & construction workers, such as vocal abuse, smoking, drinking and so on, might be a cause of high detection rate of laryngeal cancer. This is why we should like to emphasize the necessity of medical check up, particularly laryngeal examination, for the engineering & construction workers.

A Clinical Study of Reinke's Edema

A clinical study of 76 cases with Reinke's edema who underwent endolaryngeal microsurgery was carried out, and the postoperative results were evaluated. The patients were classified into three types: Type I, II, and III according to the severity of the disease as determined by laryngeal appearance. Postoperative changes in subjective symptoms were assessed and sound spectrographic and perceptual evaluations of voices were carried out before and after surgery in 38 cases. The majority of the patients were over 40 years of age for both sexes and most of the elderly patients were female. In Type III patients, the incidence was higher among females. All the patients complained of hoarseness and nine cases of Type III complained of dyspnea. Most of them had been chronically affected for over one year and showed a bilateral pathology. Smoking appeared to be the most dominant etiologic factor, while aging and a long history of vocal abuse also seemed to be causative factors. Improvement in subjective symptoms was found in almost all the patients treated with the squeezing technique proposed by the author's group. Improvement in voice quality was observed in acoustic evaluations. Among Type III females, it was often the case that the voice fundamental frequency was very low before surgery, while it increased markedly after surgery. In general, the voice after surgery showed less fluctuation in both pitch period and amplitude, as well as a smaller amount of noise components compared to that recorded before surgery. As measured by perceptual judgement, voice quality was found to be more improved in females than in males.

喉頭微細手術による呼気流率の改善について

Occasionally the air flow rate during phonation is inadequetely improved by endoscopic microsurgery for vocal cord polyps, nodules and Reinke's edema. To clarify the factors influencing the air flow rate after surgery, we studied severity of the laryngeal lesion and the improvement of hoarseness in patients with inadequete flow rate.1) In patients with polyps, the large and/or bilateral lesions appeared to cause inadequete improvement of the flow rate. There was no relationship between improvement of the flow rate and hoarseness after surgery.2) A patient with vocal cord nodules and little improvement of the flow rate had red vocal cords before surgery and no reduction of hoarseness.3) In a patient with Reinke's edema, good relief of hoarseness was obtained regard less of little improvement of flow rate which did not relate to severity of the laryngeal lesion.

咽喉頭異常感の原因的要因と遷延性要因-喉頭マイクロ手術例での検討-

Causal factor and protracted factor are suspected to cause long-standing abnormal sensation in the throat. Observation were performed before laryngo-microsurgery, immediately after surgery,3-6 weeks after operation and by "enquete" inquiry. Laryngeal diseases were considered as a causal factor. Abnormal sensation due to laryngeal polyp disappeared soon after surgery, though the sensation continued for several weeks after surgery for Reinke's edema. Laryngeal microsurgery was a causal factor. Abnormal sensation due to laryngo-microsurgery occurred more often in females, and the sensation soon subsided off. Smoking was considered as a causal factor, but not as a delayed factor. Abnormal CMI score was not a delayed factor.

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

This study was designed to analyse thyroid function in patients with Reinke's oedema. Among 43 patients, 2 new cases of myxoedema as well as 2 patients with borderline myxoedema were found. However, the majority of patients showed no indication of thyroid hypofunction. In addition the alcian-blue staining intensity of vocal cord biopsies from patients with Reinke's oedema was compared with thyroid parameters, but a relation was not found.

喉頭がんの早期診断

From May to July in 1984, we conducted a mass examination for early detection of glottic cancer and other diseases of the vocal fold in cooperation with eight health centers, twenty four E. N. T. clinics and the local press in Fukui prefecture.Six hundred and eleven patients, who complained of hoarseness, un d erwent the examination. They consisted of 343 males and 268 females. Age distribution of the patients was 68 in thirties,211 in fourties,200 in fifties,75 in sixties,50 in seventies,6 in eighties and 1 in nineties.Seven males (1.2%) wit h glottic cancer and eight males with precancer (seven with hyperkeratosis and one with leukoplakia) were found among the 611 patients.Among these laryngeal cancers, six cases were Tl a of the early stage and one was T3according to the classification of International Union Against Cancer. Among the other 596 patients,296 had chronic laryngitis,60 acute laryngitis,66 laryngeal polyp,41 Reinke's edema and 55 laryngeal nodule.Our mass examination was useful for the early detec tion of glottic cancer.

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.

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.

Acoustic screening for vocal pathology

A computer‐based acoustic system for detecting signs of laryngeal pathology from the tape‐recorded speech waveform (40 s of continuous speech) is described. The system uses a parallel processing technique for pitch detection, with phase compensation, low‐pass filtering, nonlinear smoothing for intonational baseline measurement, and local perturbation analysis. This provides two types of data: intonational data derived from the smoothed fundamental frequency trend line and waveform perturbation, which reflects irregularity of vocal fold vibration. Acoustic results are presented for a control group (100 speakers) and compared with the results for 80 speakers with known laryngeal disorders. The value of these results in screening for the effect of laryngeal abnormalities is examined. Statistical treatment of the data allows over 80% of speakers with known pathology to be differentiated from the control group. A second stage of analysis examines the possibility of using acoustic profiles to discriminate between different classes of vocal fold pathology (e.g., carcinoma, nodules, and Reinke's oedema). The relative discriminatory power of individual and combined acoustic measures is discussed. [Work supported by British Medical Research Council.]

The morphological basis for development of Reinke's oedema.

Normal human vocal cords and surgically removed Reinke's oedema were studied by light and electron microscopy. The Reinke's space between the lamina propria and vocal ligament was filled with loose connective tissue sheets, which seemed to be an organic part of the vocal ligament. The structure suggested the possibility of the lamellae moving on each other. This could be important for the vibratory function of vocal cords. Inside the lamellae, masses of inmature young elastic fibres were found. Reinke's oedema develops in the superficial elastic sheets. Therefore in the case of surgical intervention the specially structured rubbery elastic vocal cord mucosa must be removed, which is essential to perfect vibratory function.

Experience with Reinke's oedema.

In the course of their 5-year period of study the authors have observed not only the classic picture of Reinke's oedema but some of its modifications too, by applying microlaryngoscopy. The most frequent of these modifications was the phenomenon of oedematous protrusions on the border of the anterior and the median third of both vocal cords, on their free edge, and on part of the inferior surface. The histological analysis of these changes revealed the same finding as that in classic Reinke's oedema, i.e. accumulation of fluid in the loose subepithelial tissue. The authors consider the mechanical factor, i.e. misuse and overuse of the voice, responsible for the development of such circumscribed oedemas on the vocal cords. The authors were able to corroborate the known facts about the strictly defined borders of Reinke's space by experimental work on corpses. All patients were treated by means of microlaryngosurgery under general endotracheal anaesthesia. No recurrence was seen following this therapy.Wahre...

Transmission of ultrasound through the larynx as a means of determining vocal-fold activity: Hamlet, S.L., Reid, J.M. Bio-Medical Engineering Vol BME 19 No 7 (January 1972) pp 34–37

Objective: This report provides the reader with a state-of-the-art update on a number of common voice problems that require phonosurgical intervention. Study Design and Setting: This multiauthor review is not a position statement of the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) and may reflect institutional preference and/or bias. It arose from a panel discussion at the AAOHNS meeting in 2000. Results: We provide a review of the genesis and management of papillomatosis, dysplastic glottal epithelium, arytenoid granulomas, Reinke's edema, and vocal-fold paralysis. Conclusions and Significance: In the past decade, there has been a dramatic expansion of knowledge regarding a variety of voice disorders and associated treatment. There has been a convergence of basic science investigations in anatomy, physiology, and pathology with clinical trials of treatment, both surgical and nonsurgical. This information should provide the reader with current insight into critical management issues of the aforementioned disorders. (Otolaryngol Head Neck Surg 2002;126:333-48.)