Reinke's Edema: Phonatory Mechanisms and Management Strategies

Annals of Otology, Rhinology and Laryngology - Tập 106 Số 7 - Trang 533-543 - 1997
Steven M. Zeitels1, Glenn Bunting1, Robert E. Hillman1, Traci Vaughn1
1Boston, Massachusetts

Tóm tắt

Reinke's edema (RE) has been associated typically with smoking and sometimes with vocal abuse, but aspects of the pathophysiology of RE remain unclear. To gain new insights into phonatory mechanisms associated with RE pathophysiology, weused an integrated battery of objective vocal function tests to analyze 20 patients (19 women) who underwent phonomicrosurgical resection. Preoperative stroboscopic examinations demonstrated that the superficial lamina propria is distended primarily on the superior vocal fold surface. Acoustically, these individuals have an abnormally low average speaking fundamental frequency (123 Hz), and they generate abnormally high average subglottal pressures (9.7 cm H20). The presence of elevated aerodynamic driving pressures reflects difficulties in producing vocal fold vibration that are most likely the result of mass loading associated with RE, and possibly vocal hyperfunction. Furthermore, it is hypothesized that in the environment of chronic glottal mucositis secondary to smoking and reflux, the cephalad force on the vocal folds by the subglottal driving pressure contributes to the superior distention of the superficial lamina propria. Surgical reduction of the volume of the superficial lamina propria resulted in a significant elevation in fundamental frequency (154 Hz) and improvement in perturbation measures. In almost all instances, both the clinician and the patient perceived the voice as improved. However, these patients continued to generate elevated subglottal pressure (probably a sign of persistent hyperfunction) that was accompanied by visually observed supraglottal strain despite the normalsized vocal folds. This finding suggests that persistent hyperfunctional vocal behaviors may contribute to postsurgical RE recurrence if therapeutic strategies are not instituted to modify such behavior.

Từ khóa


Tài liệu tham khảo

Turck L., 1860, Chronic inflammatory disease of the vocal cord

Hajek M., 1891, Arch Klin Chir, 42, 46

Reinke F., 1895, Fortschr Med, 13, 469

Reinke F., 1897, AnatHefte, 9, 103

Hajek M., 1925, Z Hals Nasen Ohrenheilkd, 13, 161

Hirano M., 1975, Otologia (Fukuoka), 21, 239

10.1288/00005537-199503001-00001

10.1177/000348945005900224

10.1288/00005537-195404000-00003

Jackson C, Jackson CL. The larynx and its diseases. Philadelphia, Pa: WB Saunders, 1937: 136–51, 315–42.

10.1001/archotol.1940.00660010940004

Koufman JA, 1995, Diagnosis and treatment of voice disorders, 161

10.1159/000265624

10.1016/S0385-8146(88)80010-5

10.1288/00005537-199004000-00013

10.1177/000348949410300902

10.1097/00005537-199605000-00006

Hirano M, 1976, Otologia (Fukuoka), 22, 583

10.1177/000348945106000219

Fritzell B, 1986, Vocal Fold Histopathology: A Symposium, 57

10.1288/00005537-198905000-00011

10.1007/BF01069239

10.1016/0021-9924(82)90027-2

10.1044/jshr.3703.484

10.1121/1.396829

10.1016/S0892-1997(05)80082-7

10.1044/jshr.3202.373

Kambic V, 1989, Laryngorhinootologie, 68, 231, 10.1055/s-2007-998324

10.1016/S0385-8146(83)80004-2

10.1288/00005537-199401000-00012

Lore JM, 1934, Laryngoscope, 44, 803, 10.1288/00005537-193410000-00006

Toriya Y, 1979, Otologia (Fukuoka), 25, 448

10.1288/00005537-195806000-00013

10.1288/00005537-197106000-00011

Sataloff RT, 1991, Voice surgery, 227

Gould WJ, 1995, Diagnosis and treatment of voice disorders, 424

10.1177/000348949510400103

Thông tin
Thông tin xuất bản

Annals of Otology, Rhinology and Laryngology

Tập 106 Số 7

533-543

Thông tin tác giả