라인케씨 부종 환자에서 경윤상 갑상막 접근을 통한 성대 내 스테로이드 주입술의 효용

Abstract

Background and Objectives Reinke’s edema is a benign vocal fold disease caused by an edematous laryngeal superficial layer of lamina propria. The first line treatment is cessation of smoking and laryngeal microsurgery. The aim of the study is to evaluate the feasibility and efficacy of percutaneous steroid injection via cricothyroid membrane in patients with Reinke’s edema. Materials and Method From Jan 2010 to July 2018, 33 Patients with Reinke’s edema managed by vocal fold steroid injection via the cricothyroid membrane were included in this study. We compared medical records of laryngoscopy, stroboscopy and Multi-Dimensional Voice Program analysis at pre-treatment and post-treatment. Subjective voice improvement was evaluated using Voice Handicap Index-30 (VHI-30). Results 75.7% of the patients showed partial response and 6.06% showed complete response. 93.94% were present smokers and only 4 patients ceased smoking after the treatment. In acoustic analysis, the pre-treatment mean value of jitter, shimmer, and noise to harmonic ratio was 2.30±3.21, 9.34±10.37, 1.11±2.90 each. The post-treatment value was 2.20±1.89, 6.96±5.30, 0.20±0.09 respectively and none of the parameters were statistically significant. For subjective symptom improvement, 25 (75.8%) patients showed a better score on post-treatment VHI-30 compared to pre-treatment. Conclusion According to our study, steroid injection is a relatively safe and effective procedure for patients with Reinke’s edema. A vocal fold steroid injection via the cricothyroid membrane can be an alternative treatment option for those who are not able to undergo conventional laryngeal microscopic surgery, however cessation of smoking is necessary for effective treatment.