Reinke's edema and risk factors: Clinical and histopathologic aspects

doi:10.1053/ajot.2002.30961

American Journal of Otolaryngology

Volume 23, Issue 2, March–April 2002, Pages 81-84

https://doi.org/10.1053/ajot.2002.30961 Get rights and content

Abstract

Purpose: The purpose of this study was to evaluate retrospectively the distribution of histologic damage and its correlation with various risk factors in a group of patients affected by Reinke's edema. Materials and Methods: The study subjects comprised 125 patients with bilateral Reinke's edema consecutively presenting at the Department of Otorhinolaryngology, “La Sapienza” University, Rome. The patients were divided into 4 groups according to Hellquist, Lundgren, and Olofsson's histologic classification and were then further categorized according to the number of cigarettes they smoked daily. Average exposure to cigarette smoke, occupation, habitual voice use, and gastroesophageal reflux were also considered. Results: Fifty-two patients did not exhibit histologic lesions, 64 patients were histologically classified as Group 1 (epithelial hyperplasia and/or keratosis with or without mild dysplasia), and 6 patients exhibited moderate dysplasia (Group 2). In 3 patients, histologic examination showed evidence of unilateral carcinoma in situ (Group 3). Forty-four patients suffered recurrences within the first 2.5 years. Both daily cigarette consumption and duration of exposure to cigarette smoke were found to influence the severity of the histologic lesion. An association with gastroesophageal reflux was observed in 4 patients (3.2%). Prolonged vocal abuse did not prove to be a noteworthy factor in our study. Conclusions: The main risk factor for Reinke's edema and for its recurrence is tobacco use. Our study results showed that the clinical manifestation of this disease is related to the number of cigarettes smoked daily and the duration of exposure to smoke. Longer durations of exposure to cigarette smoke result in higher degrees of histologic damage. (Am J Otolaryngol 2002;23:81-84. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Section snippets

Materials and methods

The subjects in this investigation consisted of 125 patients with bilateral Reinke's edema consecutively presenting at the Department of Otorhinolaryngology, “La Sapienza” University, Rome, from 1996 to 2000. Seventy-three patients were men with a mean age of 51 years (range, 27 to 72 years), and 52 were women with a mean age of 49 years (range, 29 to 69 years). All patients underwent surgical decortication of both vocal cords by traditional microlaryngoscopy.

Fiberlaryngoscopy was used to

Reinke's edema versus histology

Fifty-two patients did not exhibit histologic lesions (Group 0) (Table 2).

. Epithelial lesions of 125 patients with Reinke's edema

Group No.	Description	No. of Patients
0	No epithelial lesion	52
1	Epithelial hyperplasia and/or keratosis with or without mild dysplasia	64*
2	Moderate dysplasia	6
3	Severe dysplasia or carcinoma in situ	3
Total		125

*32 with epithelial hyperplasia, 21 with keratosis and no dysplasia, and 11 with mild dysplasia.

Sixty-four patients were histologically classified as Group 1, 32 of whom

Discussion

The histology of Reinke's edema is characterized by different types and degrees of epithelial lesions, although a considerable number of patients do not exhibit any alterations of the epithelium.2, 3, 4, 5 Our study confirms these findings. Of the patients who underwent surgery, 41.6 % showed no epithelial lesions. This pattern was confirmed further after the recurrent lesions were treated surgically. Of the 44 patients who complained of recurrent Reinke's edema, 35 were classified as Group 0.

References (8)

H Yonekawa
A clinical study of Reinke's edema
Auris Nasus Larynx
(1988)
H Hellquist et al.
Hyperplasia, keratosis, dysplasia and carcinoma in situ of the vocal cords—A follow-up study
Clin Otolaryngol
(1982)
A Fernandez Perez et al.
A: Aspectos anatomoclinicos de las lesiones gloticas organicas de origini funcional
Acta Otorrinolaringol Esp
(1991)
NV Moesgaard et al.
Surgical treatment of Reinke's oedema (long term results)
J Laryngol Otol
(1986)

There are more references available in the full text version of this article.

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Professional singers’ careers are usually associated with health-relevant factors that they themselves may or may not be able to influence. We have therefore investigated the effect of modifiable health-related behaviors and non-modifiable factors on singers’ occupational health.
In an explorative, questionnaire-based study, self-reported, occupationally relevant health complaints and behaviors, along with singer-specific characteristics, were surveyed from 349 professional singers and voice teachers (116 men, 233 women; age 18-73 years) and the influence of age, gender, duration of daily and lifelong singing, voice category, and health-related behaviors (smoking, alcohol consumption, physical activity) on occupationally relevant health complaints were analyzed using bi- and multivariate statistical methods.
Singers reported less risky alcohol consumption (5.4% versus ≈15%) and smoking (15.5% versus 29.7%) than the general population, and too little physical activity was described in two thirds of both populations. After controlling for multiple testing, no effect was found for these behaviors, the time spent singing daily, gender, or voice categories on singers’ complaints. Health complaints were significantly fewer for males (P < .001) and older women and were reported more frequently for higher-pitched male voices, a trend not found in females.
Singers seem to smoke and drink less than members of the general population. These factors did not affect their complaints. Female singers described more work-related health complaints than males, a finding that corresponds to women in the general population. Older singers reported fewer complaints than younger singers, possibly because of selection effects or older singers acquiring strategies to avoid health-damaging behavior.
DNA rare copy number alterations in Reinke's Edema
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Reinke’s Edema (RE) is a laryngeal lesion related to excessive tobacco smoking, voice overuse, and laryngopharyngeal reflux. Although the risk of malignancy has been considered low in literature, RE is classified among precancerous lesions.
We investigated DNA Copy Number Alterations (CNAs) in specimens of RE and its potential association with malignant progression.
We used array-based comparative genomic hybridization (aCGH, Agilent 4 × 180 K platform) to study eight RE cases. All patients were heavy tobacco users for at least 30 years, and none of them progressed to cancer in the follow-up (>8 years). Two RE presented mild dysplasia, one moderate dysplasia, and no histological alterations were found in the remaining five cases. CNAs were compared with the Database of Genomic Variants (DGV) and genes mapped on altered regions had their functions annotated.
Six of eight patients showed different rare copy number alterations on chromosomes 2q37.3, 4q13.1, 4q13.3, 7q11.22, 10p14, and 13q34. A gain of the whole chromosome 8 were detected in one case. Of interest, four of eight RE cases showed copy number imbalances involving genes previously described in several tumor types (RASA3, COL6A3, LINC00707, LINP1, SMR3A, and SMR3B).
The genomic imbalances herein found in RE have the potential to contribute to the phenotype but with limited or no risk of cancer. A long-term follow-up in a large series of patients could clarify the mechanisms involved in the malignant progression of RE.
4.
Towards the Objective Speech Assessment of Smoking Status based on Voice Features: A Review of the Literature
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Citation Excerpt :
Speech signals convey a speaker's important information such as age, gender, body size, emotional state, and health state.12–16 The physiological effects of cigarette smoking have been well-documented17–19 and include pharyngeal diseases and disorders resulting from prolonged effects of a variety of harmful chemicals in the cigarette smoke. Exposure to tobacco smoke can affect throat tissues, causing inflammation to vocal-folds and misfunction of the vocal cords,20–22 along with degrading lung function and thereby decreasing the airflow through the vocal cords.21,23,24
In smoking cessation clinical research and practice, objective validation of self-reported smoking status is crucial for ensuring the reliability of the primary outcome, that is, smoking abstinence. Speech signals convey important information about a speaker, such as age, gender, body size, emotional state, and health state. We investigated (1) if smoking could measurably alter voice features, (2) if smoking cessation could lead to changes in voice, and therefore (3) if the voice-based smoking status assessment has the potential to be used as an objective smoking cessation validation method.
A systematic review of the scientific literature was conducted to compile studies on smoking status assessment based on voice features. We searched nine scientific databases for original studies involving the effects of smoking on voice features, the effects of smoking cessation on voice features.
A total of 34 studies were identified for review. We found that fundamental frequency, jitter, shimmer, harmonics to noise ratio, and other voice features are affected by smoking and could be used to assess smoking status.
Speech assessment of smoking status based on voice features has potential as a smoking status validation method, as it is simple, reliable, and less time-consuming. Furthermore, this study provides recommendations for future research on the objective speech assessment of smoking status based on voice features.
Acoustic and Auditory-Perceptual Analysis of Voice in the Female Smokers Who Do Not Have Self-Reported Voice Complaint
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Smoking affects the voice quality and the previous studies presented higher Voice Handicap Index (VHI) scores, and abnormal acoustic data in smokers. However, there is no study revealing any voice parameter indicating incipient damage in voice functionality. The studies documented that the adverse effects of smoking on phonatory function were higher in females than males and further the prevalence of smoking among females tends to increase. The purpose of this study was to investigate the effect of smoking on the acoustic and auditory-perceptual analysis of the speaking voice in female smokers who scored the VHI-10 scale as grade 0 (absent), and thus to look for a criterion for incipient vocal damage of smoking.
The study group composed of 22 female smokers and 22 female nonsmokers between the ages of 18 and 55 years. The acoustic parameters (mean F0, jitter local [%], jitter local abs, jitter rap, jitter ppq, shimmer local [%], shimmer local [dB], shimmer apq3, shimmer apq5, shimmer apq11, and mean HNR) and the GRBAS scale were analyzed in all subjects.
No significant difference observed between the smoker and nonsmokers groups in acoustic voice analysis. It was seen that the smokers presented a small but significant increase in the Strain parameter of the GRBAS scale while there was no significant difference in the Grade, Roughness, Breathiness, and Asthenia parameters between the study groups.
The results of this study indicate that increase in Strain could be considered as an early data in the smokers without voice complaints. However, our data declared that conventional acoustic perturbation analysis did not reveal incipient Strain in voice.
Reinke's Edema: New Insights into Voice Analysis, a Retrospective Study
2023, Journal of Voice
Reinke's edema (RE) is a pathological condition involving increased volume of the vocal folds and resulting in significant impact on speech, fundamental frequency, and vocal range. Literature reports few studies which analyze vocal features according to the severity of RE. The aims of this study were to investigate the aerodynamics, acoustic characteristics, and sound spectrograms of a group of RE patients and to assess whether there was any correlation with their endoscopic grading.
A total of 98 patients were included in the study, 49 patients with RE and 49 healthy volunteers (HV). Multidimensional Voice Program was used to perform objective voice assessment. Maximum phonation time (MPT) and Voice Handicap Index (VHI) questionnaire were collected. The spectrograms of the vowel /a/ and of the word /aiuole/, which contains the five Italian vowels, of each patient were analyzed according to the classification of Yanaghiara modified by Ricci Maccarini and De Colle. Laryngological assessment was used to record vocal folds morphology according to Yonekawa's classification. Univariate analysis was used to compare group outcomes. Bivariate analysis was used to compare endoscopic grading and voice analysis results.
Univariate analysis of the HV and RE groups revealed statistically significant differences (P < 0.05) for the following parameters: jitter%, shimmer%, harmonic-to-noise ratio (NHR), voice turbulence index (VTI), MPT, VHI except for soft phonation index. Spearman's rank correlation showed a positive correlation between vocal parameters such as jitter%, shimmer%, NHR, VTI, and RE gradings. A negative correlation was found between MPT and RE gradings. Bivariate analysis indicated a strong positive correlation between RE grading and the spectrogram classification performed both with the vowel / a / (Rho 0.86; P = 0.0001) and with the word / aiuole / (Rho 0.81; P = 0.0001).
The present study demonstrates that patients with RE have different voice characteristics compared to HV. In particular, the voice analysis highlighted acoustic parameters that correlated to differing degrees of RE. In addition, spectrogram analysis should be considered for acoustic assessments before and after medical and surgical therapy and also in forensic medicine.
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To identify the possible risk factors related to etiology of the minimal associated pathological lesions (MAPLs) of the vocal folds and their impacts on the recurrence of lesion.
This analytical cross-sectional study included 200 subjects presented with dysphonia to the Phoniatrics/Voice Clinics in two hospitals in Gulf region (KSA and UAE). Same number of matched voluntaires from the same hospitals (hospital staffs, employees and their relatives) and relatives of subjects with typical voice quality were included as well. Both groups underwent a simple questionnaire consists of 15 items related to previously accused risk factors of MAPLs.
The bivariant analysis by Fisher's exact test showed that male gender, presence of kids, misuse of voice, alcohol, gastroesophageal reflux diseases and voice handicapping are associated with significant risk to have MAPLs with P values < 0.001 for all except for alcohol (P = 0.015). Welch's t test revealed higher smoking index in subject than control groups with significant difference (P < 0.001). In contrast, spices, family shouting and nearby industry were not potent risk factors in our study group.
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^*: Address reprint requests to Dario Marcotullio, MD, Via Tripolitania 211, 00199 Rome, Italy.

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Original ContributionsReinke's edema and risk factors: Clinical and histopathologic aspects*

Abstract

Section snippets

Materials and methods

Reinke's edema versus histology

Discussion

Auris Nasus Larynx

Hyperplasia, keratosis, dysplasia and carcinoma in situ of the vocal cords—A follow-up study

Clin Otolaryngol

A: Aspectos anatomoclinicos de las lesiones gloticas organicas de origini funcional

Acta Otorrinolaringol Esp

Surgical treatment of Reinke's oedema (long term results)

J Laryngol Otol

Original Contributions
Reinke's edema and risk factors: Clinical and histopathologic aspects*