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Original Research—Laryngology and Neurolaryngology
Office-Based Photoangiolytic Laser
Treatment of Reinke’s Edema: Safety and
Voice Outcomes
Otolaryngology–
Head and Neck Surgery
2015, Vol. 152(6) 1075–1081
American Academy of
Otolaryngology—Head and Neck
Surgery Foundation 2015
Reprints and permission:
sagepub.com/journalsPermissions.navDOI: 10.1177/0194599815577104
http://otojournal.orgIan J. Koszewski, MD
1
, Matthew R. Hoffman, PhD
1
,
W. Greg Young, MD
1
, Ying-Ta Lai, MD
1
, and Seth H. Dailey, MD
1
No sponsorships or competing interests have been disclosed for this article.
Abstract
Objective.
To evaluate the safety, tolerability, and voice outcomes
of office-based photoangiolytic laser treatment of Reinke’s edema.
Study Design.
Case series with chart review.
Setting.
Academic medical center.
Subjects and Methods.
We performed a retrospective analysis
of patients undergoing office-based laser treatment of
endoscopy-proven Reinke’s edema. Safety and tolerability were
evaluated by reviewing complications. Voice outcomes were
analyzed by comparing pre- and postprocedural acoustic, aero-
dynamic, and Voice Handicap Index measurements. Complete
data sets were not available for all subjects; sample size for
each parameter is reported with the corresponding result.
Results.
Nineteen patients met inclusion criteria. There were
no minor or major complications. Five procedures were
truncated due to patient intolerance. Phonatory frequency
range increased (n = 12,
P
= .003), while percent jitter
decreased (n = 12,
P
= .004). Phonation threshold pressure
decreased after treatment (n = 4,
P
= .049). Voice Handicap
Index also decreased (n = 14,
P
\
.001).
Conclusion.
This study represents the largest series of
patients undergoing office-based photoangiolytic laser treat-
ment specifically for Reinke’s edema. Our data suggest that
this is a safe and effective modality to treat dysphonia asso-
ciated with Reinke’s edema, although patient intolerance of
the procedure may represent a barrier.
Keywords
Reinke’s edema, photoangiolytic laser, office-based treat-
ment, voice
Received October 24, 2014; revised January 14, 2015; accepted
February 20, 2015.
R
einke’s edema is a benign disease of the true vocal
folds, characterized by edema and vascular congestion
within Reinke’s space, leading to diffuse polypoid
degeneration. Patients are generally middle-aged women, and
they have voice complaints of abnormally low speaking pitch
and a rough voice quality.
1
Multiple risk factors have been
identified, including tobacco use, vocal abuse, and laryngo-
pharyngeal reflux.
2-5
Critical to preventing progression of the
disease and managing the dysphonia are nonsurgical strategies,
such as smoking cessation, voice therapy, and treatment of
underlying laryngopharyngeal reflux.
1,6
When a nonsurgical
approach is inadequate, surgery is employed. Traditional surgi-
cal options have focused on mucosal microflap elevation with
removal of tissue,
7,8
microdebridement,
9
carbon dioxide laser
ablation,
10,11
and cold knife cytoreduction.
12
Recently, photoangiolytic laser treatment has been pro-
posed as an alternative treatment.
13-16
Unlike traditional
methods that involve the physical removal of tissue, the
potassium titanyl phosphate (KTP) laser and pulsed dye
laser (PDL) target oxyhemoglobin and are thought to
address the vascular congestion characteristic of Reinke’s
edema. Importantly, both the KTP and the PDL have flex-
ible fibers that can be passed through a flexible endoscope
for office-based interventions, thus avoiding risks associated
with general anesthesia.
17
Performing procedures in the
office rather than the operating room has several notable
advantages, including decreased cost
18
and avoidance of the
potential complications of microlaryngoscopy, such as
dental injury and dysgeusia.
19
Office-based use of lasers for the treatment of Reinke’s
edema has gained popularity with the advent of improved
instrumentation and evidence that the procedures are safe
and cost-effective. Koufman et al and Sheu et al reported
large series demonstrating support for the use of photoan-
giolytic lasers in the treatment of an array of laryngeal
1
Department of Surgery, Division of Otolaryngology–Head and Neck
Surgery, University of Wisconsin School of Medicine and Public Health,
Madison, Wisconsin, USA
This article was presented at the 2014 AAO-HNSF Annual Meeting & OTO
EXPO; September 21-24, 2014; Orlando, Florida.
Corresponding Author:
Seth H. Dailey, MD, Division of Otolaryngology–Head and Neck Surgery,
University of Wisconsin School of Medicine and Public Health, 600
Highland Ave, Clinical Science Center-H4, Madison, WI 53792-3284, USA.
Email:
dailey@surgery.wisc.eduReprinted by permission of Otolaryngol Head Neck Surg. 2015; 152(6):1075-1081.
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