Reinke's Edema Research Articles

Bilateral Compensatory Reinke's Edema: Self-Medialization.

Bilateral Compensatory Reinke's Edema: Self-Medialization.

Risk of malignancy in patients with Reinke's Edema: evaluation of long-term follow-up results.

Reinke's edema is a benign lesion affecting the subepithelial layer of the vocal cords, often associated with moderate or heavy smoking. Smoking is the most significant risk factor for dysplastic laryngeal lesions, laryngeal carcinomas, and Reinke's edema. Thus, Reinke's edema could potentially be a predisposing factor for laryngeal malignancy in the long term. This study aimed to determine the rate of dysplasia and invasive carcinoma development in the larynx during long-term follow-up of histopathologically confirmed Reinke's edema. Between 2010 and 2019, 28 patients diagnosed with Reinke's edema via microlaryngoscopy and histopathological confirmation were included in this study. Their clinical and pathological data were examined to identify the development of laryngeal dysplasia and malignancy during long-term follow-up. Among the 28 patients, 16 (57%) were female and 12 (43%) were male. A history of smoking was present in 24 (85%) patients. No new pathology was found during long-term follow-up in 21 (75%) patients. None of the patients developed dysplasia or malignancy histopathologically. Seven (25%) patients underwent repeated biopsies during follow-up, and minimal dysplasia was detected in 1 (4%) patient. No invasive carcinoma developed in any patient during long-term follow-up. Despite the high rate of smoking among patients with Reinke's edema, no malignancy developed during long-term follow-up, though there was a low incidence of dysplasia. Therefore, close monitoring of these patients is recommended.

Effective Treatments for Abductor Vocal Cord Paralysis: A Comprehensive Review.

Abductor vocal cord paralysis (AVCP) is a disabling disorder that affects the voice and the quality of life of a patient, and hence, there is importance in providing a detailed knowledge of its aetiology and management. In this review article, we offer an implicational definition of AVCP and a discussion of its background, viewed as potentially affecting voice production and health. Finally, we explore modalities of diagnosis by medical history and physical examination, visualization techniques like laryngoscopy and stroboscopy, and radiographic imaging such as computed tomography (CT) and magnetic resonance imaging (MRI) scans. The article reviews and categorizes approaches into operative and non-operative treatments, including injection laryngoplasty, voice therapy, botulinum toxin injections, and the management of Reinke's edema. Surgical approaches, like arytenoid adduction, cordotomy, and posterior cordotomy, are also scrutinized taking their indication, efficacy, and complication profile into consideration. Learning about the advantages and drawbacks of the following experimental yet promising directions like nerve-muscle pedicle implantation, nerve reinnervation, and engineering of tissues is therefore highly necessitated. In conclusion, the review details the measures that have shown to be useful in the treatment process and their impact on the future practice of clinical work, calling for a more clarified structure of the organization of diagnostic, therapeutic, and rehabilitative activities. Future research directions are outlined based on the gaps which include the development of new treatment approaches, the evaluation of treatment for long-term effects, and the need for interdisciplinary cooperation in the medical field for the benefit of the patients.

Acoustic Character Governing Variation in Normal, Benign, and Malignant Voices.

Benign and malignant vocal fold lesions (VFLs) are growths that occur on the vocal folds. However, the treatments for these two types of lesions differ significantly. Therefore, it is imperative to use a multidisciplinary approach to properly recognize suspicious lesions. This study aimed to determine the important acoustic characteristics specific to benign and malignant VFLs. The acoustic model of voice quality was utilized to measure various acoustic parameters in 157 participants, including individuals with normal, benign, and malignant conditions. The study comprised 62 female and 95 male participants (43 ± 10 years). Voice samples were collected at the Shanghai Eye, Ear, Nose, and Throat Hospital of Fudan University between May 2020 and July 2021. The acoustic variables of the participants were analyzed using Principal Component Analysis (PCA) to present important acoustic characteristics that are specific to normal vocal folds, benign VFLs, and malignant VFLs. The similarities and differences in acoustic factors were also studied for benign conditions including Reinke's edema, polyps, cysts, and leukoplakia. Using the PCA method, the components that accounted for the variation in the data were identified, highlighting acoustic characteristics in the normal, benign, and malignant groups. The analysis indicated that coefficients of variation in root mean square energy were observed solely within the normal group. Coefficients of variation in pitch (F0) were found to be significant only in benign voices, while higher formant frequencies and their variability were identified as contributors to the acoustic variance within the malignant group. The presence of formant dispersion (FD) as a weighted factor in PCA was exclusively noted in individuals with Reinke's edema. The amplitude ratio between subharmonics and harmonics (SHR) and its coefficients of variation were evident exclusively in the polyps group. In the case of voices with cysts, both pitch (F0) and coefficients of variation for FD were observed to contribute to variations. Additionally, higher formant frequencies and their coefficients of variation played a role in the acoustic variance among voices of patients with leukoplakia. Experimental evidence demonstrates the utility of the PCA method in the identification of vibrational alterations in the acoustic characteristics of voice affected by lesions. Furthermore, the PCA analysis has highlighted underlying acoustic differences between various conditions such as Reinke's edema, polyps, cysts, and leukoplakia. These findings can be used in the future to develop an automated malignant voice analysis algorithm, which will facilitate timely intervention and management of vocal fold conditions.

Neural network architectures in data sequence analysis: diagnosis of Reinke's oedema and Laryngeal polyps

In this review paper, we focus our attention on presenting selected neural network architectures dedicated to the analysis of sequential data, in particular to support the diagnosis of Reinke's oedema and laryngeal polyps. The research discussed here is located in the area of clinical computer decision support systems (CDS) based on the use of artificial recurrent neural networks (RNNs) for speech signal analysis. RNNs are able to predict time series due to their memory and local recurrent connections. In the experimental part, Elman-Jordan artificial neural networks are used, whose characteristics are speed and accuracy in pattern learning allowing real-time decision-making. In the review presented here, one important theme is the use of Bezier curves for preprocessing the speech signal, leading to data reduction and noise elimination. Elman-Jordan networks significantly speed up the learning process and show high classification accuracy in laryngopathy diagnosis.

Nonlinear Dynamic Analysis and Perturbation Measurement Used for Discriminating Pathological Voices and Their Correlations With Perceptual Evaluation

1. To investigate the discriminatory and diagnostic power of nonlinear dynamic analysis measures concerning voices from normal, benign, and malignant voice disorders. 2. To study the correlations of nonlinear dynamic analysis measures with perceptual ratings to evaluate the reliability of the objective acoustic analysis in predicting severity of voice. The perturbation analysis metrics used were Jitter%, Shimmer%, and signal-to-noise ratio. The nonlinear dynamic analysis metrics used were spectrum convergence ratio (SCR), nonlinear energy difference ratio (NEDR), and rate of divergence (ROD). Subjects were enrolled and divided into three groups based on laryngeal pathology: normal, benign, and malignant. Vowel sound and reading samples were recorded. Perceptual evaluation was applied to these voice samples to investigate correlations between metrics and auditory perception. Each metric was capable of discriminating laryngeal pathology, except for SCR in the case of distinguishing between benign and malignant pathologies. Perturbation analysis parameters had a moderate ability to differentiate between normal and benign pathologies, but were unable to characterize malignant pathologies for certain diseases, such as Reinke's edema. All metrics significantly correlated with perceptual G scores. Nonlinear dynamic analysis was superior when applied to cases of severe dysphonia, where linear metrics such as Jitter% and Shimmer% tended to lose utility. NEDR and ROD were successful at differentiating between the different pathologies, whereas SCR could not discriminate between the benign and malignant groups. Perturbation and nonlinear dynamic analyses are comparable in their discriminating power with respect to normal and benign voices, and normal and malignant voices. The nonlinear dynamic analysis metrics NEDR and ROD may be superior in clinical settings with respect to discriminating voice pathology ranging from mild pathological voice to severe dysphonia, and with respect to discriminating benign and malignant voice. SCR was found unable to discriminate pathological voices.

Conservative Management of Early Grade Unilateral Reinke's Edema with Laryngopharyngeal Reflux

Reinke's edema is described as fluid-filled vocal folds in the Reinke's space. Unilateral cases are uncommon and might caused by gastrointestinal reflux. We report a 61-year-old man with complaints of hoarseness since one year ago, which was getting worse for the past two months. Examination of the reflux symptom index (RSI) obtained a score of 23 and reflux finding score (RFS) score of 11. Examination of the flexible fiber laryngoscopy showed that the right vocal fold size was thicker than the contralateral side, greyish in color, soft, and did not bleed easily. The patient was then given conservative therapy with proton pump inhibitors (PPIs), corticosteroids, and mucolytics, accompanied by lifestyle modifications. Clinical improvement was found at four weeks of evaluation. In conclusion, the response to conservative therapy and elimination of risk factors for early-stage Reinke's edema contributes well to disease recovery, particularly those caused by laryngopharyngeal reflux.

Reinke's Edema and Risk Factors, A Case-Control Study.

Reinke's edema (RE) is a benign pathological non-inflammatory disorder of the vocal folds with a wide range of clinical manifestations. We aim to investigate the relationship between Reinke's edema and some common inhalant abuse. In this case-control study, subjective consisted of 23 patients with RE (the cases), and 50 patients with sinusitis (control) who underwent surgery in the Department of Otolaryngology, between 2015 and 2020. Demographic characteristics, history of some related disease, methods, and the duration of cigarette, and opium consumption were collected through the patients' files. The chi-square (χ²) test was run to analyze the differences in the categorical and, and the Independent Sample T-test was used to compare two sample means from unrelated groups. A significant level (p-value) was considered less than 0.05. The mean age was 54 ± 12 years, and 42 ± 11 years, respectively for Reinke's edema and sinusitis. More women had been recorded in the RE group, compared to men. Allergy, unprincipled use of voice and talkativeness, history of laryngeal surgery, and type of disease were correlated to RE (p < 0.05). Also, cigarette smoking was significantly correlated with Reinke's edema. The average number of cigarettes per day, the duration of smoking, and opium consumption were more frequent in RE (P < 0.05). 90% of the RE and 4% of sinusitis patients were opium consumers. There was a statistically significant difference in the methods of substance use in the two groups of cases and control (p < 0.0001). Among the different methods, the poker and stone method was the most common (69.6%), and the opium smoking pipe was the second most common method. This study also confirmed the hazardous effects of smoking and inhaling opiates in the formation of lesions of the pharynx and larynx. In particular, longer use of these substances will be associated with more serious side effects. Therefore, it seems that people who are addicted to opiates should undergo periodic visits and counseling to reduce and stop their use.

Impact of the Severity of Reinke's Edema on the Parameters of Voice.

This study aimed to classify the degree of edema in patients with Reinke's edema (RE) and examine its impact on their voice parameters using both objective and subjective assessment methods. Objective and subjective voice data of 104 patients diagnosed with RE between 2018 and 2021 were evaluated retrospectively. RE is classified into 4 groups (types 1, 2, 3, and 4). The evaluation included videolaryngostroboscopic examination, acoustic voice analysis, and aerodynamic measurements, GRBAS, Voice Handicap Index-10 (VHI-10), Voice-Related Quality of Life Scale (V-RQOL), and Reflux Septum Index (RSI). Patients with type 1 RE had a significantly lower mean age than those with types 3-4. Although there were no significant differences in acoustic and aerodynamic parameters between the groups, it was observed that F0 and the maximum phonation time decreased as the degree of edema increased. The GRBASTotal, G, and R scores of types 1 and 2 were significantly lower than those of types 3 and 4, as were the scores of type 1 S. There were no statistically significant differences between the RE groups in terms of VHI-10, V-RQOL, and RSI scores. It has been observed that as the severity of RE increases, voice perception and quality (especially types 3 and 4) are negatively affected. Determining the degree of edema will guide the clinician in both the planning of the intervention phase and the follow-up phase.

Reassessing the Role of Phonomicrosurgery and Smoking Status in the Management of Reinke's Edema.

To elucidate recurrence patterns of Reinke's edema (RE) following phonomicrosurgery and compare current and former smokers' outcomes. 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. 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. 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. 3 Laryngoscope, 134:2659-2663, 2024.

Prevalence of Benign Vocal Fold Lesions: Long-Term Results From a Single European Institution

Hoarseness and limited voice capacity are often associated with benign vocal fold (VF) lesions. Despite their high clinical prevalence, epidemiological investigations focusing on these structural alterations are rare. The aim of the study was to present current European data on five typical lesion types (VF nodules, polyp, cyst, contact granuloma, Reinke´s edema). Retrospective investigation. Video recordings of laryngoscopies from all patients with one of the above-mentioned VF pathologies were subjected to a review process. Data collected arose from a single institution over a period of 13years. They were evaluated statistically with respect to lesion type, sex, age at first diagnosis, and affected side. In a total of 535 patients, VF polyps occurred most frequently, followed by Reinke's edema and nodules. Each of the lesion types studied was significantly associated with sex and, except VF cysts, all diagnoses were also significantly related to age. Female sex was a risk factor for VF nodules, cysts, and Reinke's edema, whereas male sex was associated with polyps and contact granulomas. VF nodules occurred predominantly in young patients, VF polyps in middle-aged, Reinke's edema, and contact granulomas in later adulthood. The predominantly affected side (bilateral, right, or left VF) depended on sex. Different prevalences from previous studies resulted from inconsistencies in terms of classification framework, terminology, and definition. In addition to endoscopic findings, socio-cultural backgrounds must also be considered when studying benign VF lesions. Prophylactic voice care education for all populations and concomitant efficacy studies are required. Further research is needed to verify possible correlations between sex and the affected side. A non-binary view could broaden the spectrum of phoniatric research issues.

The Safety and Efficacy of the 445-nm Blue Laser for Operative Management of Benign Nonvascular Laryngeal Lesions

Adult voice center patients who underwent surgical intervention for vocal fold (VF) mass, VF scar, laryngeal stenosis, laryngeal web, or Reinke's edema were included in this retrospective study. Outcomes were compared to those achieved when traditional treatment modalities were used, including cold steel, CO2 laser, potassium-titanyl-phosphate (KTP) laser, and coblator. Strobovideolaryngoscopy footage was evaluated using a previously described model at four time points: postoperative visit #1: 1-14 days, postoperative visit #2: 30-60 days, postoperative visit #3: 61-365 days, postoperative visit #4: >365 days. Eighty cases using the blue laser and 153 controls (n=78 cold steel, n=51 KTP laser, n=22 CO2 laser, n=2 coblator) were included in this study. Procedures performed using blue laser included VF mass excision (n=45), VF scar reduction (n=16), laryngeal stenosis resection/repair (n=25), laryngeal web excision (n=7), and reduction of Reinke's edema (n=1). On postoperative strobovideolaryngoscopy examination, the surgical objective score did not differ significantly between the blue laser cohort and all controls at any postoperative visit. VF edema did not differ significantly between the blue laser cohort and all controls at any postoperative visit. VF hemorrhage scores were significantly lower in the blue laser cohort compared to all controls at the first postoperative visit, but hemorrhage had resolved almost entirely by the second postoperative visit in all groups. Postoperative VF stiffness was worse in the blue laser group at the third postoperative visit compared to controls, but both groups had improved to similar levels by the fourth postoperative visit. The rate of lesion recurrence (24.29% versus 17.19%) did not differ significantly between the blue laser cohort and controls on multivariate analysis (Odds ratio [OR]=1.081 [0.461-2.536]). The complication rate (12.50% versus 10.46%) did not differ significantly between the blue laser cohort and all controls on multivariate analysis (OR=0.992 [0.375-2.624]). The blue laser was associated with a lower rate of revision surgery (30.00% versus 34.64%) on multivariate analysis (OR=0.380 [0.168-0.859]). The 445-nm blue laser is safe and effective for the management of benign laryngeal lesions. It has efficacy and safety similar to those of traditional treatment modalities (including cold steel, CO2 laser, and KTP laser). Use of the blue laser may lead to lower rates of early postoperative hemorrhage and revision surgery. No adverse effects attributed directly to the use of the blue laser were observed in this study. Further research is encouraged to confirm or refute these findings.

Pathogenesis of Reinke's Edema of the Vocal Fold.

The most frequent etiologic factor of Reinke's edema (RE) is considered to be smoking. However, the mechanism for the onset and development of the disease remains unclear. Hypoxia-inducible factor-1α (HIF-1α) is an oxygen-dependent transcriptional activator which plays crucial roles in angiogenesis in hypoxic microenvironments. HIF-1α induces the expression of vascular endothelial growth factor (VEGF) which involves angiogenesis and enhances vascular permeability. This study investigated the roles of HIF-1α in the pathogenesis of RE. Surgical specimens of RE from patients who underwent endolaryngeal microsurgery were used. Normal vocal folds were used as a control group. Expression of HIF-1α and VEGF was analyzed by immunohistochemistry. Three-dimensional fine structures of the vessels in RE were investigated using correlative light and electron microscopy (CLEM) technique. HIF-1α and VEGF were broadly expressed in the stromal, inflammatory, and endothelial cells in the lamina propria of the vocal fold of RE. The expression of HIF-1α and VEGF of RE were significantly higher than in the lamina propria of the normal vocal fold mucosa. CLEM showed vascularization and telangiectasia and there were many dilated capillaries with thin endothelium not covered with pericytes indicating the vessels were fragile. Transcription factor HIF-1α and induced VEGF likely play roles in the pathogenesis of RE. And increased vascular permeability with fragile vessels in angiogenesis is likely to be an etiology of RE. Transcription factor HIF-1α and induced VEGF are potential therapeutic targets for RE. NA Laryngoscope, 134:1785-1791, 2024.

Laryngopharyngeal Reflux and Benign Vocal Fold Lesions: A Systematic Review and Meta-analysis.

There is a link between laryngopharyngeal reflux (LPR) and the formation of benign vocal fold lesions (BVFLs). However, previous studies have mainly focused on LPR suggested by symptoms and signs, rather than objectively diagnosed LPR via pharyngeal pH monitoring. We, therefore, conducted a Meta-analysis to evaluate the association between pharyngeal pH monitoring diagnosed LPR and the odds of BVFLs. Relevant observational studies were identified by searching PubMed, Embase, Cochrane Library, and Web of Science. We evaluated between-study heterogeneity using the Cochrane Q test and estimated the I2 statistic. Random-effects models were used when significant heterogeneity was observed; otherwise, fixed-effects models were used. Thirteen datasets from 9 studies were included. Among them, 493 were diagnosed with LPR and 344 had BVFLs. LPR was related to a higher odds of BVFLs (odds ratio: 3.26, 95% confidence interval: 1.84-5.76, P < .001) with moderate heterogeneity (P for Cochrane Q test = .006, I2 = 57%). Subgroup analyses showed that the association was similar in studies with only pharyngeal pH monitoring (Restech), with double-probe or 3-site pH monitoring, and with 24-hour multichannel intraluminal impedance-pH monitoring (P for subgroup difference = .15). In addition, subgroup analysis showed consistent results in studies from Asia and Europe (P for subgroup analysis = .12), and the association seemed to be consistent for vocal Reinke's edema, nodules, and polyps (P for subgroup difference = .09). Pharyngeal pH monitoring diagnosed LPR is associated with the formation of BVFLs.

Indications, Efficacy, Safety, and Clinical Outcomes of 585 nm Pulsed Dye Laser in Non-Malignant Laryngeal Lesions: A Systematic Review.

The objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions (p < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures.

Risk factors for postoperative vocal fold fibrosis following microlaryngeal surgery.

To analyze the risk factors for postoperative vocal fold fibrosis (PVF) in patients undergoing microlaryngeal surgery (MLS) for benign vocal fold lesions. Retrospective study. We retrospectively included patients who had undergone MLS for vocal polyps, nodules, mucus retention cysts, fibrous mass, or Reinke's edema. Data on the patients' clinicodemographic characteristics and intraoperative findings were obtained by reviewing their clinical records. PVF was defined by the presence of an adynamic segment of membranous vocal folds or a marked reduction in mucosal wave amplitude on post-MLS (6 weeks) videolaryngostroboscopy. The risk factors for PVF were analyzed through univariate and multivariate logistic regressions. This study included 89 patients, of whom 16 (18%) were given a diagnosis of PVF. A significantly increased incidence of PVF was noted in patients with fibrous mass (p < .01). The univariate analysis indicated that lesion attachment to the vocal ligament, prolonged surgical duration (>60 min), and symptom duration (>12 months) were significantly correlated with PVF (p < .05). The multivariate analysis confirmed that diagnosis of fibrous masses, lesion attachment to the vocal ligament and symptom duration are significant risk factors for PVF. PVF is more common in patients with fibrous masses. Lesions attachment to the vocal ligament and prolonged symptom duration appear to be other significant risk factors for PVF. 4.

Reinke’s Edema: New Insights into Voice Analysis, a Retrospective Study

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. 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. 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). 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.

Comparing Effects of Short- and Long-Term Exposure of Cigarette Smoke Extract on Human Vocal Fold Fibroblasts

To explore the effects of short- and long-term cigarette smoke extract (CSE) stimulation on the expression of extracellular matrix (ECM) components and inflammatory cytokines in an in vitro model for studying Reinke's edema using human vocal fold fibroblasts (hVFF). Experimental pilot study using intervention with CSE in vitro. Immortalized hVFF were pretreated with 5% CSE or control medium over a period of 2 or 8weeks, followed by a final 3-day incubation time. We evaluated cell proliferation and examined gene and protein expression of control- and CSE-treated cells using quantitative polymerase chain reaction, Western Blot and enzyme linked immunosorbent assay. Cell numbers of CSE-treated hVFF strongly decreased after 8weeks and limited the overall duration of the experiment. We observed significant upregulations in gene expression and protein levels of inflammatory markers (cyclooxygenase COX1, COX2) and ECM components (decorin, matrix metalloproteinase 1, transglutaminase 2, gremlin 2) induced by CSE after 2 and 8weeks. Interleukin 1 receptor 1, prostaglandin I2 synthase, collagen- and hyaluronan-related gene expression showed minor upregulations. The majority of the observed genes were similarly regulated at both time points. However, the CSE-induced mRNA level of COX1 was ablated after 8weeks. Long-term treatment did not yield results significantly different from the short-term protocol. Therefore, we propose that prolonged CSE exposure is not superior to short-term settings, which save both time and materials.

Voice outcomes in high-grade Reinke's edema: Comparing microflap excision and microdebrider surgery.

Patients presenting with hoarseness and diagnosed with high-grade Reinke's edema (RE) will often require surgical intervention for polypoid changes of the true vocal folds. We compared patient outcomes in patients who had microflap or microdebrider excision surgeries. Patients with the diagnosis of grade II or grade III RE based on laryngoscopy or videostroboscopy who failed conservative management underwent surgery using the standard excision practice of the primary surgeon. Voice outcomes were compared using VHI-30 (Voice Handicap Index), V-RQOL (Voice-Related Quality of Life), and MPT (maximum phonation time) preoperatively and at 1-month and 6-months postoperatively. Of the 115 patients included, there were 46 RE grade II patients and 69 RE grade III patients with 52 patient undergoing microflap surgery and 63 patients undergoing microdebrider surgery. Both procedures resulted in significant improvement in VHI-30, V-RQOL, and MPT at 1-month and 6-months postoperatively. The microdebrider group had better 6-month VHI scores (40.84) than the microflap group (44.54) (CI -7.27 to -0.12). The microdebrider group also had better 6-month V-RQOL measures (62.56) than the microflap group (57.79) (CI 0.38-9.16). Both microflap excision and microdebrider excision for high-grade RE lesions resulted in significant improvement in VHI-30, V-RQOL, and MPT at 1-month and 6-months postoperatively with the microdebrider excision group scoring statistically significantly better at 6 months in comparison to the microflap group. Overall, the results support the use of both surgical modalities for treating high-grade RE patients. 3.

Reinke's Edema: Cold Steel Versus Radiofrequency Coblation.

This study compared the effects of radiofrequency (RF) coblation and cold steel (CS) surgery for the treatment of Reinke's edema (RE). 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. 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. The RF coblation procedure is a reliable and safe method for RE surgery, offering an effective treatment choice for RE.