This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Moorthy, S.S. Articles by Pfefferkorn, T. Search for Related Content PubMed PubMed Citation Articles by Moorthy, S.S. Articles by Pfefferkorn, T.

Anesthetic implications of Reinke’s edema of vocal cords

Roudebush VA Medical Center, Indianapolis, USA, E-mail: sreenivasa.moorthy{at}med.va.gov

To the Editor:

Reinke’s edema (RE) also known as polypoid corditis, laryngitis, degeneration or chronic hypertrophic laryngitis^1,2 is associated with chronic accumulation of fluid in the subepithelial compartment of the vocal fold.² The etiology of RE is not known. It is more common in females, and often associated with smoking, vocal abuse and gastroesophageal reflux disease (GERD). Unilateral RE, sometimes resembling a cyst, may be associated with vocal cord paresis. RE can be a complication following prolonged tracheal intubation. Patients with unsuspected RE can present airway obstruction under anesthesia.³

The treatment of RE may be conservative, treating the GERD with medications (omeprazole), stopping smoking and reducing voice abuse. The surgical treatment consists of excising the lesions, medialization laryngoplasty for vocal cord paresis, and excision of the superficial lamina propria of the vocal folds by surgery or CO₂ laser technique. ^4,5

We have managed two patients with RE. In both cases we could identify the polypoid appearance of the vocal fold (Figure) during laryngoscopy. We provided anesthesia for laryngoscopy or laryngoscopic surgery with propofol induction and succinylcholine muscle relaxation for tracheal intubation, using a smaller 6 or 7 mm internal diameter endotracheal tube with ease. We maintained anesthesia with sevoflurane, oxygen and air and provided muscle relaxation with mivacurium. Following tracheal extubation we administered iv dexamethasone 10 mg and recemic epinephrine inhalation treatment (racepinephrine 0.5 mL in 3 mL of normal saline in nebulizer) for glottic edema. Neither patient experienced airway complications, and both recovered uneventfully.

View larger version (155K): [in this window] [in a new window]   FIGURE Fibreoptic bronchoscopic view of laryngeal opening in an elderly patient with hoarseness of voice showing bilateral Reinke’s edema, more on the left.

References

1 Marcotullio D, Magliulo G, Pietrunti S, Suriano M. Exudative laryngeal diseases of Rienke’s space: a clinicohistopathological framing. J Otolaryngol 2002; 31: 376–80.[Medline]

2 Koufman JA, Belafsky PC. Unilateral or localized Rienke’s edema (pseudocyst) as a manifestation of vocal fold paresis: the paresis podule. Laryngoscope 2001; 111: 576–80.[Medline]

3 d’Hulst D, Butterworth J, Sebron D, Oaks T, Matthews B. Polypoid hyperplasia of the larynx misdiagnosed as a malpositioned laryngeal mask airway. Anesth Analg 2004; 99: 1570–2.[Abstract/Free Full Text]

4 Slavit DH. Phonosurgery in the elderly: a review. Ear Nose Throat J 1999; 78: 505–9.[Medline]

5 Nielsen VM, Hojslet PE, Karlsmose M. Surgical treatment of Rienke’s oedema (long-term results). J Laryngol Otol 1986; 100: 187–90.[Medline]

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Moorthy, S.S. Articles by Pfefferkorn, T. Search for Related Content PubMed PubMed Citation Articles by Moorthy, S.S. Articles by Pfefferkorn, T.