Role of Laryngeal Ultrasonography in screening for laryngeal diseases in symptomatic patients

Background Laryngoscopy is widely considered the most appropriate tool for evaluating the larynx, however, it is invasive and not all patients can tolerate it. Although laryngeal ultrasound has been proposed as a promising noninvasive technique that can play an important role in laryngeal imaging, there is lack of consensus regarding its role. Objective The aim of this study is to assess laryngeal ultrasound sensitivity compared to indirect laryngoscopy in screening for laryngeal diseases in symptomatic patients. Patients and methods 30 undiagnosed symptomatic patients underwent laryngeal ultrasound and indirect laryngoscopy. Their results were compared. Results Technical success rate of laryngeal ultrasound was (83%). It showed overall sensitivity of (78.9%) in detecting organic laryngeal diseases with high sensitivity in detecting laryngeal masses, reinke’s edema, vocal cord cysts and polyps (100%), vocal cord palsy (83.3%), intermediate sensitivity for vocal cord nodules (66.7%), and poor sensitivity for laryngitis and non organic voice disorders (0%). Conclusion Laryngeal ultrasound is a useful non invasive imaging tool that can be used with acceptable sensitivity in detecting organic laryngeal diseases excluding laryngitis, hindered mainly by complete thyroid cartilage calcification in older males. Consequently we recommend its use as complementary to clinical examination and mirror laryngoscopy, or as an alternative to indirect laryngoscopy when required and in routine neck ultrasound exams when appropriate.

Multiple laser puncture for Reinke’s edema: surgical outcome and voice assessment

<p class="abstract"><strong>Background: </strong>The two important principles in Reinke’s edema treatment are minimal intervention and superficial resection with evacuation the edema and preservation the medial edge of the vocal fold to improve the voice quality. The aim of this study was to evaluate a novel surgical technique in treatment of Reinke’s edema and its effect on subjective and quantitative voice characteristics. The study design was a prospective clinical series.</p><p class="abstract"><strong>Methods: </strong>We evaluated 67 patients from 19 to 73 years (mean, 47.7 years) with Reinke’s edema. The patients were divided into 3 types, mild, moderate and sever. Clinical voice assessment was composed of stroboscopy, subjective voice evaluation (GRBAS hoarseness scale) and quantitative voice evaluation were evaluated pre- and postoperatively. All patients underwent endolaryngeal CO2 laser puncturing for treatment of Reinke’s edema.</p><p class="abstract"><strong>Results: </strong>67 patients diagnosed as Reinke’s edema were classified by H. Yonekawa classification into three types. Type I 25 (37.3%) patients, type II 30 (44.8%), type III 12 (17.9%). Out of 67 patients, fifty two (77.6%) were smoker. In all the patients, the laryngostrobscopic findings showed an improvement of mucosal wave patterns with little vocal fold scaring. Significant vocal improvement was also noted in subjective and objective voice assessments.</p><p class="abstract"><strong>Conclusions: </strong>The laser puncture technique is safe, effective and less invasive to treat Reinke’s edema with significant improvement in vocal performance after surgery.</p>

Vocal Fold Fibroblasts in Reinke’s Edema Show Alterations Involved in Extracellular Matrix Production, Cytokine Response and Cell Cycle Control

The voice disorder Reinke’s edema (RE) is a smoking- and voice-abuse associated benign lesion of the vocal folds, defined by an edema of the Reinke’s space, accompanied by pathological microvasculature changes and immune cell infiltration. Vocal fold fibroblasts (VFF) are the main cell type of the lamina propria and play a key role in the disease progression. Current therapy is restricted to symptomatic treatment. Hence, there is an urgent need for a better understanding of the molecular causes of the disease. In the present study, we investigated differential expression profiles of RE and control VFF by means of RNA sequencing. In addition, fast gene set enrichment analysis (FGSEA) was performed in order to obtain involved biological processes, mRNA and protein levels of targets of interest were further evaluated. We identified 74 differentially regulated genes in total, 19 of which were upregulated and 55 downregulated. Differential expression analysis and FGSEA revealed upregulated genes and pathways involved in extracellular matrix (ECM) remodeling, inflammation and fibrosis. Downregulated genes and pathways were involved in ECM degradation, cell cycle control and proliferation. The current study addressed for the first time a direct comparison of VFF from RE to control and evaluated immediate functional consequences.

Hyaluronic Acid Concentration in Female Vocal Folds With Reinke’s Edema

Objective The aim of the present study was to investigate hyaluronic acid (HA) concentrations in vocal folds among patients with Reinke’s edema. Study Design Prospective and experimental study. Setting Single tertiary center. Methods An HA binding protein isolated from bovine nasal cartilage was used to identify and isolate the HA from samples. Plates coated with biotin-conjugated binding protein and streptavidin-europium conjugate were sequentially incubated with 18 Reinke’s edema samples and 11 female vocal fold cover samples from cadavers (the superficial layer of the lamina propria; control group). After the release of europium from streptavidin in enhancement solution, final fluorescence was measured in a fluorometer. Results The mean HA concentration in Reinke’s edema vocal folds was significantly higher than that in the control vocal folds (9.2 × 103 vs 0.9 × 103µg/g). Conclusion Vocal fold covers affected by Reinke’s edema present a higher concentration of HA than do vocal fold covers with no edema.

Resolution of Muscle Tension Dysphonia with Reinke’s Edema Following STRETTA Therapy in a Patient with GERD: A Case Report

Muscle Tension Dysphonia (MTD) is a syndrome involving abnormal vocal cord behaviour due to increased tension of laryngeal musculature. It has a complex etiology, but gastroesophageal reflux disease (GERD) is implicated in up to half of cases. The authors present the first reported case of MTD being successfully treated using STRETTA, an endoscopic radio-frequency therapy, licenced for GERD. Since 2016, a 60- year-old female had symptoms of laryngo-pharyngeal reflux. These included dysphonia, cough, sore throat, and persistent throat clearing. She underwent flexible nasendoscopy demonstrating significant posterior laryngeal edema, and anterior-posterior constriction on phonation, suggestive of MTD. Despite anti-reflux medication, her symptoms persisted. Repeat flexible nasendoscopy demonstrated bilateral Reinke's edema. Her symptoms failed to improve despite incision and drainage of the Reinke’s edema. An EGD demonstrated reflux esophagitis, and a blunt angle of His. She underwent STRETTA and reports significant improvement of symptoms. Repeat nasoendoscopy showed convalescence of the Reinke’s edema. Existing evidence suggests that management of MTD with proton pump inhibitor (PPI) improves reflux symptoms such as chronic cough and heartburn but has a limited effect on measures of voice such as voice range profile, perceptual evaluation, and acoustic analysis. Given that the present patient found subjective improvement in voice quality, it is possible STRETTA may be preferable to PPI in treating MTD with regard to voice, but further assessment of voice quality pre- and post-STRETTA is needed. In LPR refractory to PPI, there is evidence that Laparoscopic Nissen Fundoplication (LNF) is successful; however, the cost-effectiveness of endoscopic anti-reflux procedures such as STRETTA is superior to operative management such as LNF. Therefore, STRETTA may well be more beneficial than both PPI and LNF in the treatment of MTD with LPR.