Reinke's Space Research Articles

Surgical management of voice disorders

ErratumJournal of VoiceVol. 2Issue 3Preview Full-Text PDF

Vocal cord hemorrhages in voice professionals

Summary Singers and other professional voice users may present with hemorrhages of vocal cords following vocal trauma. Several such patients were examined by indirect laryngoscopy, videostrobofiberoscopy, and electrolaryngography. Data were collected on a videotape by dynamic vocal exploration. In 14 cases (12 women and 2 men) without prior treatment, anticoagulants, salicylates, or bleeding disorders, 2 bilateral and 12 unilateral hemorrhages were observed. These patients, with subepithelial hematomas and Reinke's space edema, were studied and followed up for 1 year. The patients with bilateral hemorrhage underwent medical treatment for 1 month and voice rest for 2 weeks. After 1 month, the speaking voice was normal, and the singing voice was almost as it was before the hemorrhage. After 2 months, the voice was entirely recovered for short periods of use, with nearly normal vocal folds. However, voice fatigue after 15 min, occurred, and microvarices were still visible. After 3–6 months, the speaking and singing voice was as before the accident. Of the 12 unilateral hemorrhages, three cases were cured after 1 month of medical treatment, and nine required surgery (CO 2 laser under general anesthesia with microendoscopy technique) despite 5 weeks to 6 months of medical treatment. Two patients were operated on at 5 weeks to evacuate the subepithelial hematoma, and seven were operated on at 6 months to treat the aftereffects.

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...

Pathology and etiology of vocal nodule

Now question arises, how reaction is initiated which results in formation of nodules ? Considering the relative avascularity and peculiar anatomy, it is more rational to imagine that local oedema in Reinke's space is the primary reaction to trauma or irritation to vocal cords rather than granulomatous reaction. This localised oedema disrupts elastic fibres in Reinke's space. The chronic irritation due to persistence of causative factors stimulates fibroblastic reaction and invasion by new blood vessels with granulation tissue formation. Further histopathological features are determined by the predominance of one structure over the other and associated secondary changes such as hyaline degeneration, which is very common