Reinke's edema and risk factors: Clinical and histopathologic aspects

Purpose: The purpose of this study was to evaluate retrospectively the distribution of histologic damage and its correlation with various risk factors in a group of patients affected by Reinke's edema. Materials and Methods: The study subjects comprised 125 patients with bilateral Reinke's edema consecutively presenting at the Department of Otorhinolaryngology, "La Sapienza" University, Rome. The patients were divided into 4 groups according to Heliquist, Lundgren, and Olofsson's histologic classification and were then further categorized according to the number of cigarettes they smoked daily. Average exposure to cigarette smoke, occupation, habitual voice use, and gastroesophageal reflux were also considered. Results: Fifty-two patients did not exhibit histologic lesions, 64 patients were histologically classified as Group 1 (epithelial hyperplasia and/or keratosis with or without mild dysplasia), and 6 patients exhibited moderate dysplasia (Group 2). In 3 patients, histologic examination showed evidence of unilateral carcinoma in situ (Group 3). Forty-four patients suffered recurrences within the first 2.5 years. Both daily cigarette consumption and duration of exposure to cigarette smoke were found to influence the severity of the histologic lesion. An association with gastroesophageal reflux was observed in 4 patients (3.2%). Prolonged vocal abuse did not prove to be a noteworthy factor in our study. Conclusions: The main risk factor for Reinke's edema and for its recurrence is tobacco use. Our study results showed that the clinical manifestation of this disease is related to the number of cigarettes smoked daily and the duration of exposure to smoke. Longer durations of exposure to cigarette smoke result in higher degrees of histologic damage.