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

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Office-based blue laser therapy for vocal fold polyps and Reinke's edema: a case study and review of the literature.

PURPOSE: To report the efficacy of blue laser in the treatment of vocal fold polyps and Reinke's edema in an office setting. METHODS: The medical records and video-recordings of patients who underwent office-based blue laser therapy in a tertiary referral center for vocal fold polyps and/or Reinke's edema were reviewed. The primary outcome measures were the Voice Handicap Index-10 (VHI-10) score and disease regression. Acoustic and aerodynamic parameters were also analyzed. RESULTS: Thirty-five patients (21 with vocal fold polyps and 14 with Reinke's edema) were included and a total of 47 lesions were treated. Out of the 35 patients, 7 patients were lost for follow-up. The mean VHI-10 score dropped significantly after surgery by 17.41 ± 8.67 points (p < 0.001). The endoscopic examinations of 38 lesions were reviewed (17 vocal fold polyps and 21 Reinke's edema) before and up to 6 months after laser therapy. In the subgroup with vocal fold polyps (N = 17), there was complete disease regression in 13 and partial in 4. In the subgroup with Reinke's edema (N = 21), there was complete disease regression in 7 and partial disease regression in 14. For patients with vocal fold polyp, there was a significant decrease in shimmer and a significant increase in maximum phonation time postoperatively. For patients with Reinke's edema, there was a significant decrease in shimmer and noise-to-harmonic ratio following treatment. CONCLUSION: Office-based blue laser therapy is an effective treatment for vocal fold polyps and Reinke's edema leading to complete or partial disease regression. All patients had improvement in voice quality.

Histopathological changes of parotid and larynx in hypothyroid rats: experimental study.

OBJECTIVES: In this study, we aimed to investigate the laryngeal and parotid histopathological alterations in rats with experimentally induced postnatal hypothyroidism. MATERIALS AND METHODS: 200-300 g weighed Wistar albino rats were included in this study. The rats were randomly divided into four groups: group 1 is control and the other groups are experimental groups. Food and water were supplied ad libitum in group 1, no medication was administered. Propylthiouracil (PTU) was administered intraperitoneally for 15 days in group 2; for 30 days in group 3, for 45 days in group 4. The larynx and parotid glands of the rats were removed and intracardiac blood samples were collected for thyroid-stimulating hormone (TSH) analysis under anesthesia (ketamine hydrochloride, 100 mg/kg) 24 h after the last PTU injection. The same procedures were done for the control group at day 46. Histopathological evaluation was done for all the specimens. RESULTS: While submucosal vascular dilatation was significantly higher in the experiment groups (p < 0.05), there was not a significant difference in lamina propria edema, inflammation, goblet cell loss, cilia loss between the groups in larynx specimens. In parotid gland specimens, serous asinus atrophy, stromal connective tissue increase were significantly higher in experiment groups (p < 0.05). In addition, there was a significant difference in nuclear morphology between control and experimental groups (p < 0.05). CONCLUSION: The results of the study showed that hypothyroidism may have effect on inflammatory procedure by causing vascular dilation in larynx and serous asinus atrophy nucleus changes, connective tissue increase in stroma in parotid gland.

Phonosurgery of Reinke's edema with microdebrider.

PURPOSE: To present our experience with a new microsurgical approach for treatment of the Reinke's edema in suspension laryngoscopy-microdebridement. After a short review of existing literature we introduce speech therapy before and after the surgery into the protocol. METHODS:  The authors compare the phonatory outcome, laryngostroboscopical results and subjective improvement of the voice of 30 patients with Reinke's edema that were operated with either microdebridement or cold steel surgery techniques. "Sandwich" speech therapy strategy was applied for the vocal rehabilitation before and after surgery in both patient groups. RESULTS: After the microdebridement and the speech therapy the mucosal wave was regular, symmetric and periodic in all patients. No signs of abnormal scar tissue or anterior adhesions were observed. Significant improvement of vocal parameters was found after the surgery in both groups of patients: operated with the microdebridement technique and the cold steel technique. The subjective voice evaluated by Voice Handicap Index (VHI-10) was improved for both patient groups in a homogenous way. CONCLUSIONS: Based on the similarity of the vocal outcome in the two groups, microdebridement of the vocal folds is an excellent method for removing the edema of the Reinke's space. Careful suction at a low voltage protects the lamina propria during the microdebridement. The authors discuss the indication to this innovating procedure in patients with difficult laryngeal exposure and small operating field.

High-resolution magnetic resonance and mass spectrometry imaging of the human larynx.

High-resolution, noninvasive and nondestructive imaging of the subepithelial structures of the larynx would enhance microanatomic tissue assessment and clinical decision making; similarly, in situ molecular profiling of laryngeal tissue would enhance biomarker discovery and pathology readout. Towards these goals, we assessed the capabilities of high-resolution magnetic resonance imaging (MRI) and matrix-assisted laser desorption/ionisation-mass spectrometry (MALDI-MS) imaging of rarely reported paediatric and adult cadaveric larynges that contained pathologies. The donors were a 13-month-old male, a 10-year-old female with an infraglottic mucus retention cyst and a 74-year-old female with advanced polypoid degeneration and a mucus retention cyst. MR and molecular imaging data were corroborated using whole-organ histology. Our MR protocols imaged the larynges at 45-117 µm2 in-plane resolution and capably resolved microanatomic structures that have not been previously reported radiographically-such as the vocal fold superficial lamina propria, vocal ligament and macula flavae; age-related tissue features-such as intramuscular fat deposition and cartilage ossification; and the lesions. Diffusion tensor imaging characterised differences in water diffusivity, primary tissue fibre orientation, and fractional anisotropy between the intrinsic laryngeal muscles, mucosae and lesions. MALDI-MS imaging revealed peptide signatures and putative protein assignments for the polypoid degeneration lesion and the N-glycan constituents of one mucus retention cyst. These imaging approaches have immediate application in experimental research and, with ongoing technology development, potential for future clinical application.

Proteomic Analysis of Vocal Fold Fibroblasts Exposed to Cigarette Smoke Extract: Exploring the Pathophysiology of Reinke's Edema.

Reinke's edema is a smoking-associated, benign, mostly bilateral lesion of the vocal folds leading to difficulties in breathing and voice problems. Pronounced histological changes such as damaged microvessels or immune cell infiltration have been described in the vocal fold connective tissue, the lamina propria Thus, vocal fold fibroblasts, the main cell type of the lamina propria, have been postulated to play a critical role in disease mediation. Yet information about the pathophysiology is still scarce and treatment is only surgical, i.e. symptomatic. To explore the pathophysiology of Reinke's edema, we exposed near-primary human vocal fold fibroblasts to medium conditioned with cigarette smoke extract for 24 h as well as 4 days followed by quantitative mass spectrometry.Proteomic analyses after 24 h revealed that cigarette smoke increased proteins previously described to be involved in oxidative stress responses in other contexts. Correspondingly, gene sets linked to metabolism of xenobiotics and reactive oxygen species were significantly enriched among cigarette smoke-induced proteins. Among the proteins most downregulated by cigarette smoke, we identified fibrillar collagens COL1A1 and COL1A2; this reduction was validated by complementary methods. Further, we found a significant increase of UDP-glucose 6-dehydrogenase, generating a building block for biosynthesis of hyaluronan, another crucial component of the vocal fold lamina propria In line with this result, hyaluronan levels were significantly increased because of cigarette smoke exposure. Long term treatment of 4 days did not lead to significant changes.The current findings corroborate previous studies but also reveal new insights in possible disease mechanisms of Reinke's edema. We postulate that changes in the composition of the vocal folds' extracellular matrix -reduction of collagen fibrils, increase of hyaluronan- may lead to the clinical findings. This might ease the identification of better, disease-specific treatment options.

Reinke's edema: a proposal for a classification based on morphological characteristics.

PURPOSE: Reinke's edema is a benign laryngeal condition characterized by swelling of the superficial layer of the lamina propria of the vocal fold. The aim of this work is to propose a new classification of Reinke's edema based on its morphological characteristics. METHODS: Our classification is a synthesis of the classifications available in the literature and is based on morphological characteristics such as the involvement of one or two vocal folds and the presence or absence of polypoid lesions regardless of the observation method. RESULTS: We indicate four types of Reinke's edema: type 1: Reinke's edema of one vocal fold; type 2: Reinke's edema of both vocal folds; type 3: Reinke's edema of one vocal fold with associated polypoid lesion, not necessarily the same fold of the edema; type 4: Reinke's edema of both vocal folds with associated polypoid lesion on one or both folds. CONCLUSION: Our proposed classification for Reinke's edema represents a synthesis of the classifications available in the literature and is characterized by a simple categorization based on morphological characteristics commonly visible through laryngoscopy.

Two-handed tying technique in vocal fold mucosa microsuture for the treatment of Reinke's edema.

BACKGROUND: Removal of Reinke's edema may result in moderate to large-sized mucosal defect on the vocal fold, which heals by secondary intention. Microsuturing this defect may lead to primary wound healing with fastened recovery and less scar, but costs extra time and effort. Exploring methods that can shorten microsuture time is helpful for the wider application of this technology. STUDY DESIGN: Retrospective. METHODS: 57 patients with Reinke's edema, who were admitted from November 2010 to June 2018, were enrolled as research subjects for the retrospective analysis. 27 patients were the knot pusher group (from November 2010 to March 2015), and 30 patients were the two-handed tying group (from April 2015 to June 2018). Evaluation indicators include the number of knots, the average time for suturing and tying the knot for each patient, and the occurrence of complications, subjective and objective voice assessments. RESULTS: All patients underwent successful operation. The average time for making knots in the knot pusher group and two-handed tying group was 668.40 ± 173.73 s and 328.73 ± 121.0 s, respectively, and there was a statistically significant difference between the two groups (p < 0.001). No significant difference was noted in the mucosal avulsion, overall incidence of complications between the groups, and no significant difference was found between the two groups in terms of the preoperative and 3-month postoperative subjective and objective indicators. CONCLUSION: Microsuturing of Reinke's edema microflaps using the two-handed tying technique can achieve the similar effect with the knot pusher method, and save operation time while the surgeon is well trained. LEVEL OF EVIDENCE: 4.

The association of sulcus vocalis and benign vocal cord lesions: intraoperative findings.

OBJECTIVE: To investigate the presence of sulcus vocalis in patients who underwent phonomicrosurgery due to benign vocal cord lesions. METHODS: Between January 2013 and June 2018, the records of 133 patients who underwent operations for benign vocal fold pathology were retrospectively reviewed. Intraoperative findings of the patients were noted. Patients were divided into two groups: patients with only benign vocal fold lesions (BVFL) and patients with benign vocal fold lesions and accompanying sulcus vocalis (SV + BVFL). RESULTS: In total, 67 patients (50.4%; 38 females, 29 males) had BVFL and 66 (49.6%; 37 females, 29 males) had SV + BVFL. The patients in the SV + BVFL group were significantly younger than those in the BVFL group (p = 0.039). The sulcus was unilateral in 60.6% of the patients. The presence of sulcus vocalis was 49% and 47.6% in patients with a diagnosis of polyps (n = 51) and cysts (n = 42), respectively. A total of 12 of 13 patients with multiple benign vocal fold lesions had accompanying sulcus vocalis. CONCLUSION: Approximately half of the patients who underwent operations for benign vocal fold lesions had accompanying sulcus vocalis. More than half of the sulcus associated with benign lesions was unilateral.

[The clinical and functional condition of the larynx in the patients of the elder age group presenting with chronic oedematous polypoidal laryngitis]. / Kliniko-funktsional'noe sostoianie gortani u patsientov starshei vozrastnoi gruppy s khronicheskim otechno-polipoznym laringitom.

This article was designed to report the results of the evaluation of the clinical and functional condition of the larynx in the patients of the elder age group presenting with chronic oedematous polypoidal laryngitis before and after their surgical treatment. A total of 60 patients at the age from 60 to 72 years were available for the examination; all of them had a concomitant somatic or ENT pathology. The clinical and functional conditions of the larynx in the patients of the elder age group were studied, with special reference to those suffering from chronic oedematous polypoidal laryngitis before the surgical intervention, that determined the overall clinical picture of the disease characterized in the first place by the predominance of the severe polypoid process with the combination of the organic and functional laryngeal pathology. The specific clinical and functional features of the larynx were identified after the surgical treatment that exerted the appreciable influence on the postoperative course of the disease and the duration of dysphonia. The peculiarities of postoperative laryngitis are described. Its catarrhal form was diagnosed in 42% of the patients. The strong inflammatory reaction with exudation and formation of fibrin films was documented in 58% of the patients while 83% of them exhibited formation of the functional component of dysphonia that required the application of the additional therapeutic measures for the complete restoration of the vocal function taking into consideration the age-related alteration of the larynx together with the long-term postoperative observation of the patients.

Analysis of Potassium Titanyl Phosphate Laser Settings and Voice Outcomes in the Treatment of Reinke's Edema.

OBJECTIVE: Despite increased clinical utility of the 532-nm potassium titanyl phosphate (KTP) laser, no studies have examined outcomes for Reinke's edema (RE) as a function of laser parameters and initial treatment effects. Variability in delivery parameters, fiber-to-tissue distance, and immediate end-tissue effects limits universal application of existing study outcomes. We examine voice outcomes using standardized treatment classification, providing justification for laser parameter selection and immediate tissue effect in clinical use. METHODS: Retrospective review of 9 patients who underwent KTP laser treatment for RE. Demographics, RE severity, laser settings, total laser energy, and immediate tissue effects were correlated with quantified voice outcomes. RESULTS: An average of 157 joules (6-640 J) was delivered over a 0.369-second exposure time (0.1-0.9 seconds). Immediate tissue effects varied from nonablative treatment (type I and type II) to ablation without tissue removal (type III). Overall, Voice Handicap Index-10 (VHI-10) decreased by 8.23; improvement was most pronounced with type II treatments (delta VHI-10=12). No complications were encountered. CONCLUSION: Potassium titanyl phosphate laser can be safely and effectively used to improve voice in RE patients regardless of severity. This is the first study to provide detailed information on laser settings, energy delivery, and treatment effect in RE management; these results may guide clinical use of this modality, especially for novice laser surgeons.

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.

Office-Based Blue Laser Therapy vs Thulium Laser Therapy for Reinke's Edema.

OBJECTIVE: To compare the treatment outcomes of patients with Reinke's edema (RE) who were treated in-office using the blue laser vs those treated in-office using the thulium laser. STUDY DESIGN: Retrospective case-control study. METHODS: The medical records and video recordings of patients who underwent office-based thulium laser therapy for RE between November 2018 and July 2019, and office-based blue laser therapy for RE between November 2023 and March 2024 in a tertiary referral center were reviewed. The primary outcome measures used in this study were the Voice Handicap Index-10 (VHI-10) score and disease regression based on the laryngeal examination performed before and after therapy. RESULTS: Twenty-two patients were included in this study. They were divided into 2 subgroups, 12 patients with 22 lesions who underwent office-based thulium therapy and 10 patients with 17 lesions who underwent office-based blue laser therapy. There was no significant difference in the decrease in the mean VHI-10 score following surgery between those treated with the thulium laser vs those treated with the blue laser (10.5 ± 13.15 vs 8.2 ± 5.98, P = 0.657). Nine out of 22 lesions (40.9%) treated with thulium laser regressed completely compared to 9 out of 17 lesions (52.9%) treated with a blue laser. The difference in disease regression between the two subgroups was not statistically significant (P = 0.455). CONCLUSIONS: Blue laser and thulium laser can be used interchangeably in-office for the treatment of RE with no significant difference in patient self-perceived improvement in voice quality and disease regression. A larger study using objective measures is warranted.

Pathogenesis of Reinke's Edema of the Vocal Fold.

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. LEVEL OF EVIDENCE: NA Laryngoscope, 134:1785-1791, 2024.

A Rare Cause of Acute Dyspnoea: Reinke Oedema.

Reinke oedema is a benign condition due to fluid collection within subepithelial space of the true vocal fold. This phenomenon is predisposed by chronic smoking, alcohol consumption and contribution of laryngopharyngeal reflux. Although benign, it may be life threatening when bilateral vocal folds are affected causing airway obstruction. In this report, awake tracheostomy was performed for a 65- year- old lady with stridor secondary to severe Reinke oedema. The importance of establishing a definitive airway is highlighted here in securing a difficult airway. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03714-4.

Reinke Edema: Factors that Interfere with Vocal Recovery after Surgery.

Introduction Dysphonia and lower pitch after surgery of Reinke edema are common. They are caused especially due to chronic smoking but, probably, other factors should be associated. Objectives To evaluate the results of laryngeal microsurgery in patients with Reinke edema, following a standardized postoperative guidance protocol in our service. Methods Retrospective study. Thirty patients (3 males; 27 females) were included, 70% between 41 and 60 years old. The parameters analyzed in the pre- and postoperative (between 4 and 6 months) of patients undergoing laryngeal microsurgery for Reinke edema were: smoking, vocal symptoms, videolaryngostroboscopy, voice therapy, perceptual and acoustic vocal evaluation, histopathological report. Results Smoking was reported by 100% of the patients and maintained in the postoperative period by 80%. Complete improvement of symptoms in the postoperative period was reported by 43% of them, partial improvement by 40%, and maintenance by 17%. There was low adherence to voice therapy in the pre- and postsurgery. Postoperative videolaryngoscopy indicated congestion (19), atrophy and bowed vocal fold (1), subepithelial edema (2), and normal findings (8). The histological findings were subepithelial edema, enlargement of vessels, inflammation, epithelial hyperplasia, and thickening of the basement membrane. The perceptual and acoustic vocal analyzes indicated improvement of the analyzed parameters. Conclusions The maintenance of some vocal symptoms and laryngeal alterations in videolaryngoscopy after microsurgery of Reinke edema is frequent, even in patients who follow the recommendations of vocal rest and control of gastroesophageal reflux. Vocal symptoms are attributed to changes in the laryngeal mucosa caused by chronic smoking, aggravated by the maintenance of addiction in the postoperative period.

Reinke's Edema: Cold Steel Versus Radiofrequency Coblation.

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

Office-based Laser Therapy in Reinke's Edema: A Systematic Review and Meta-analysis.

OBJECTIVE: To analyze voice outcomes and lesion regression in patients with Reinke's edema treated in the office with lasers. STUDY DESIGN: Systematic review and meta-analysis METHODS: The search was performed in the Medline, Embase, Medline, Cochrane, and Google Scholar databases using the PRISMA framework. There were no limitations to the year of publication and the search included studies looking at voice outcomes and lesion evolution of in-office laser treatment for Reinke's edema measured through voice-handicap index, acoustic analysis or aerodynamics measures. Risk of bias was assessed using Cochrane's ROBINS-I tool for observational studies. Data analysis was performed SPSS software with a significance level of 5%. RESULTS: The initial search identified 650 articles, 6 of which met the inclusion criteria and were analyzed. The total number of participants was 58. Meta-analysis showed significant improvement in VHI-10 scores after in-office laser therapy (95% CI, [-1.46; -0.75]). It also showed significant improvement in jitter, significant increase in fundamental frequency (95% CI, [0.52; 1.71]) and significant decrease in lesion size (95% CI, [-2.03; -0.35]). CONCLUSION: Office-based laser therapy is a reliable alternative to the traditional phono-microsurgery performed in the operating room. Patients show significant improvement in voice outcomes and laryngeal examination.

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

PURPOSE: 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. METHODS: 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. 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). CONCLUSION: 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.

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

Objectives: 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. Methods: 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. Results: 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). Conclusion: 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. Level of evidence: 3.