REINKES-EDEMA - PHONATORY MECHANISMS AND MANAGEMENT STRATEGIES

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.