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Reinke edema: signs, symptoms, and findings on strobovideolaryngoscopy.

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A 45-year-old, female middle school choral teacher presented with gradually worsening dysphonia. She described a decrease in her upper range, difficulty with her passaggio, and a slight decrease in breath support. Although her complaints primarily involved singing, during the school year she also had experienced intermittent hoarseness, occasional "tight throat" when teaching, and vocal fatigue that increased in severity and duration toward the end of the school year. She denied voice breaks, weak voice, breathiness, decreased projection, and difficulty producing loud or soft volume. Her dysphonia was exacerbated by both prolonged speaking and singing, and by lack of sleep. She had occasional throat clearing with phlegm, postnasal drip, and cough. She is a nonsmoker and denied any history of laryngeal trauma or thyroid disease.

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Videostroboscopic examination of the larynx revealed Reinke edema and changes associated with laryngopharyngeal reflux (LPR), including interarytenoid erythema, posterior "cobblestoning," and vocal fold edema (figure 1). The reflux finding score was 7.

Common causes of Reinke edema include smoking, voice abuse, laryngopharyngeal reflux, and hypothyroidism. Reinke edema is characterized by increased fibrin and vasculature, as well as accumulation of gelatinous fluid in Reinke's space (figure 2). The vocal folds may appear swollen, floppy, or polypoid; hence, alternative names such as polypoid corditis, polypoid degeneration, and edematous hypertrophy have been used to describe this process. The condition tends to

occur more often in middle-aged women, with an insidious onset of symptoms such as hoarseness, vocal fatigue, stridor, and a low-pitched, husky voice. Most patients have bilateral involvement of the vocal folds.

Treatment consists of first removing the irritant responsible through interventions such as smoking cessation or voice modification. If LPR is suspected, treatment includes antireflux medications and lifestyle/ dietary modifications. Reinke edema often persists despite medical management, and surgical treatment may be warranted.

If surgical treatment is pursued, the senior author (R.T.S.) recommends operating on only one vocal fold initially, followed by the second vocal fold after the first has healed. Often, there is substantial improvement after the first operation, and patients commonly choose to seek no further operative treatment. Moreover, if stiffness occurs on the operated side, Reinke edema on the unoperated side usually prevents the development of a strained, effortful voice by permitting contact with pliable, edematous mucosa. The operation involves incising the superior surface of the vocal fold, followed by suction to remove the accumulation of edematous material from Reinke's space. If redundant mucosa is present, it may be trimmed conservatively and the mucosal edges reapproximated.

Danielle Gainor, MD; Farhad R. Chowdhury, DO; Robert T. Sataloff, MD, DMA, FACS

From the Department of Otolaryngology--Head and Neck Surgery, Drexel University College of Medicine, Philadelphia.

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Title Annotation:LARYNGOSCOPIC CLINIC
Author:Gainor, Danielle; Chowdhury, Farhad R.; Sataloff, Robert T.
Publication:Ear, Nose and Throat Journal
Article Type:Case study
Geographic Code:1USA
Date:Apr 1, 2011
Words:447
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