- Smoking (97% of cases are smokers)
- Gastro-oesophageal reflux
- Hypothyroidism
- Voice overuse
- Female gender - perhaps because the characteristic lowering of vocal pitch is more noticeable in women
Reinke's Oedema
Reinke's Oedema
This slightly left-field topic is included largely for personal interest.
Detailed knowledge is almost certainly outside the scope of the FRCA exam, though notionally falls under the curriculum item "Identifies...other pathological causes of upper airway obstruction"
Resources
- Reinke's oedema is a chronic, benign, inflammatory condition of the larynx
- It involves swelling of the superficial lamina propria of the vocal fold a.k.a. Reinke's space
- First identified by German anatomist Friedrich Reinke in 1895, the condition has an incidence of <1%
- Change in voice; typically a deepening and 'roughening' of the voice
- Hoarseness
- Dysphonia
- Dyspnoea
Diagnosis
- ENT referral with history and vocal cord examination e.g. endoscopy of some description
- ± SLT input
- Check TFTs
Management
- Treat the underlying cause:
- Smoking cessation
- PPIs for reflux
- Treatment of hypothyroidism
- Ongoing SLT input
- Surgical excision of inflamed tissue (multiple options exist)
- Patients are more likely to have OSA
- Among those with confirmed OSA, those with Reinke's oedema have higher Epworth scores
- Evidence about anaesthetic sequelae is largely confined to the realm of case reports, but Reinke's oedema has been associated with:
- Varying degrees of glottic obstruction
- Greater difficulty of intubation
- Failed intubation, with consequent waking of the patient and awake tracheal intubation thereafter
- The upshot is one should:
- Plan for a difficult airway
- Use, or have available, smaller sized ETTs
- Refrain from applying PPV through a SAD in such patients, as it may lead to billowing of the oedematous vocal folds and glottic obstruction
- Avoid excessive crystalloid administration, which may exacerbate the swelling
- Be mindful of avoiding airway trauma e.g. with repeated attempts at largyngoscopy, use of stylets/bougies
- Acknowledge that prone or Trendelenburg positioning may exacerbate the condition and have consequences at extubation
- Consider a cuff leak test prior to extubation ± use of IV steroids (let's be honest they probably received dexamethasone anyway...)