Unilateral or localized Reinke's edema (pseudocyst) as a manifestation of vocal fold paresis: The paresis podule

Background: The nosology of free-edge vocal fold lesions remains imprecise. In particular, the lesion termed pseudocyst remains enigmatic, because its histology is poorly defined and because its etiology is unknown. We define pseudocyst as a discrete, unilateral, localized area of Reinke's edema (wi thout a capsule), usually occurring at the midportion of the free-edge stri king zone. Objective: To report the demographic and clinical findings, as w ed as discuss our diagnostic and therapeutic strategies, in patients with u nilateral Reinke's edema or pseudocyst. Methodology: All patients diagnosed with unilateral Reinke's edema or pseudocyst over a 2-year period (1998-19 99) were identified from the clinical database of the Center for Voice Diso rders of Wake Forest University, Winston-Salem, North Carolina. The record of each patient was retrospectively reviewed, Results: Thirteen patients we re identified 12 of whom were female. The mean age was 36 years. Sixty-nine percent (9 of 13) had unilateral pseudocyst and 31% (4 of 13) had unilater al Reinke's edema W patients had documented vocal fold paresis on laryngeal electromyography. The 9 patients with pseudocyst underwent excision of the ir lesions; 7 had bilateral medialization laryngoplasties, 1 had lipoinject ion, and 3 did not have surgical intervention Significant improvement was n oted postoperatively on a self-administered glottal insufficiency (symptom) index (P <.001), Conclusion: Unilateral Reinke's edema and localized Reink e's edema (pseudocyst) are distinct clinical entities, occurring most frequ ently in women in their fourth decade, The finding of unilateral Reinke's e dema or pseudocyst should alert the clinician to the likelihood of vocal co rd paresis. Surgical intervention with medialization laryngoplasty appears to be beneficial.