Sm. Zeitels et al., REINKES-EDEMA - PHONATORY MECHANISMS AND MANAGEMENT STRATEGIES, The Annals of otology, rhinology & laryngology, 106(7), 1997, pp. 533-543
Reinke's edema (RE) has been associated typically with smoking and som
etimes with vocal abuse, but aspects of the pathophysiology of RE rema
in unclear. To gain new insights into phonatory mechanisms associated
with RE pathophysiology, we used an integrated battery of objective vo
cal function tests to analyze 20 patients (19 women) who underwent pho
nomicrosurgical resection. Preoperative stroboscopic examinations demo
nstrated 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), an
d they generate abnormally high average subglottal pressures (9.7 cm H
2O). The presence of elevated aerodynamic driving pressures reflects d
ifficulties in producing vocal fold vibration that are most likely the
result of mass loading associated with RE, and possibly vocal hyperfu
nction. Furthermore, it is hypothesized that in the environment of chr
onic glottal mucositis secondary to smoking and reflux, the cephalad f
orce on the vocal folds by the subglottal driving pressure contributes
to the superior distention of the superficial lamina propria. Surgica
l reduction of the volume of the superficial lamina propria resulted i
n a significant elevation in fundamental frequency (154 Hz) and improv
ement in perturbation measures. In almost all instances, both the clin
ician 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 o
bserved supraglottal strain despite the normal-sized 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.