The surgical treatment of Reinke’s oedema traditionally involves a cold steel incision placed in the lateral aspect of the vocal fold with aspiration of the characteristic gelatinous contents. In this paper, the authors compare voice outcomes in patients treated with either the carbon-dioxide laser (n = 10) or the laryngeal microdebrider (n = 16). Specifically, the carbon-dioxide laser was used in the first group for a lateral mucosal incision followed by aspiration of the vocal fold contents, whereas a cold-steel incision was used in the second group followed by microdebrider debulking of vocal fold contents and redundant mucosa. The laser settings were 1W, superpulse, continuous mode whilst the microdebrider was used in oscillation mode with a maximum speed of 800 rpm and low suction. The trial design was prospective and randomised, with the voice assessors blinded to treatment arm. Comparison of pre- and postoperative voice quality on the GRBAS scale showed consistent improvement in all parameters in both the laser and the microdebrider group, although the improvements in breathiness and strain parameters were not statistically significant in either group. Improvements in grade of hoarseness, roughness and asthenia were reported to be significantly greater after microdebrider surgery relative to laser surgery. Improvements in other acoustic voice parameters (fundamental frequency, jitter, shimmer, noise-to-harmonic ratio and maximal phonation time) were additionally significantly greater in the microdebrider group. It is debatable whether the carbon dioxide laser is an appropriate comparator to use in surgery for Reinke’s oedema. Nevertheless the use of the microdebrider to facilitate the surgical treatment of Reinke’s is conceptually appealing, and this paper would appear to confirm that good voice outcomes can be achieved. 

Assessment of voice quality after carbon dioxide laser and microdebrider surgery for reinke edema.
Burduk PK, Wierzchowska M, Orzechowska M, Kaźmierczak W, Pawlak-Osińska K.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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