Reinkes Oedema

Reinke's oedema is a chronic, diffuse, mainly bilateral, oedematous swelling of the membranous part of the vocal cords [177]. Several synonyms for RO have been used, such as polypoid vocal fold, polypoid degeneration, chronic polypoid chorditis and chronic oedematous hypertrophy [320]. The specific morphologic features of Reinke's space, such as sparse lymphatic drainage and its sharply demarcated borders, except the lateral one, contribute to the development of RO [158, 177, 179, 308, 309]. Various mechanical and chemical aetiologic factors are related to the development of RO, including overuse or abuse of the voice, and cigarette smoking. The role of constitutional and hormonal disturbances such as hypothyroidism, remains uncertain [32, 177, 308, 395]. The lesion appears most commonly in women of 20-40 years of age with hoarseness as the leading symptom.

Laryngoscopically, the surface of the swollen vocal cords along their entire length is smooth, translucent and jelly-like, with a clearly visible capillary network. Incision yields a characteristic yellowish or gelatinous fluid (Fig. 7.5a) [177, 226].

Histologically, an excessive accumulation of oedema is a leading microscopic feature. Increased thickness of the walls of the teleangiectatic blood vessels, and thickening of the epithelial basement membrane complete the classical triad of morphologic changes. The sulphat-ed glycosaminoglycans are probably responsible for the characteristic blue-coloured abundant amorphous material in the subepithelial stroma in haematoxylin and eosin (H&E)-stained slides (Fig. 7.5b) [238]. Fragility and alterations in the walls of blood vessels, such as thin endothelium with many fenestrae and vesicles, and thickened basement membrane, revealed by electron microscopy, are considered important in the development of RO [320]. Connective tissue proliferation, especially with aging of the lesion, makes the lesion irreversible unless surgical removal is provided. Changes in the covering squamous epithelium of all three exudative lesions are expected to be only reactive (squamous cell hy-perplasia, basal and parabasal cell hyperplasia) and may turn with aging and enlargement of the lesions into atrophic epithelium. Exceptionally, 12 (1.7%) patients with potentially malignant lesions (atypical hyperplasia, and LIN I and II) were found in a review of two comprehensive studies. No malignant alteration was reported within these two studies [177, 226].

In the early stage, only voice rehabilitation and avoidance of irritating factors should be attempted. However, microlaryngoscopic excision is required in the great majority of cases. Following surgery, voice therapy is often indicated [32, 177, 386].

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