C. Kothe

Forced inspiration: a laryngoscopy-based maneuver to assess the size of Reinke's edema.

INTRODUCTION Reinke’s edema was first described by the laryngologist Hajek in 1891 as edema of the larynx. Friedrich Berthold Reinke reported about injection of fluids into the vocal fold in an excised human larynx study, creating an artificial edema similar to the clinically well-known vocal fold edema. Today, Reinke’s edema is one of the most often diagnosed benign organic lesions causing a voice disorder. Rigid laryngoscopy with telescopes is used to visualize organic structure, morphological appearance, and extension of laryngeal diseases. Furthermore, videostroboscopy can provide information about the dynamic properties of benign mass lesions of the vocal folds. However, clinical experience reveals that clinical endoscopy with or without stroboscopy may not always reliably predict the actual size of Reinke’s edema, compared with estimations of actual size of edema given when surgery of the Reinke’s edema is performed using general anesthesia. A clinical maneuver that helped the authors to improve preoperative assessment of the size of Reinke’s edema during rigid laryngoscopy is reported.

Prediction of practical performance in preclinical laboratory courses – the return of wire bending for admission of dental students in Hamburg

Although some recent studies concluded that dexterity is not a reliable predictor of performance in preclinical laboratory courses in dentistry, they could not disprove earlier findings which confirmed the worth of manual dexterity tests in dental admission. We developed a wire bending test (HAM-Man) which was administered during dental freshmen’s first week in 2008, 2009, and 2010. The purpose of our study was to evaluate if the HAM-Man is a useful selection criterion additional to the high school grade point average (GPA) in dental admission. Regression analysis revealed that GPA only accounted for a maximum of 9% of students’ performance in preclinical laboratory courses, in six out of eight models the explained variance was below 2%. The HAM-Man incrementally explained up to 20.5% of preclinical practical performance over GPA. In line with findings from earlier studies the HAM-Man test of manual dexterity showed satisfactory incremental validity. While GPA has a focus on cognitive abilities, the HAM-Man reflects learning of unfamiliar psychomotor skills, spatial relationships, and dental techniques needed in preclinical laboratory courses. The wire bending test HAM-Man is a valuable additional selection instrument for applicants of dental schools.

Experiences with intraoperative application of prednisolone during Isshiki type I thyroplasty

Laryngeal edema is considered a postoperative problem in phonosurgery. In a prospective study we examined if a single intraoperative application of prednisolone can decrease the incidence of postoperative laryngeal edema after Isshiki type I thyroplasty. We examined ten patients undergoing unilateral type I thyroplasty [seven men and three women, age range: 19-60 years (average: 48 years)]. In six patients we administered 250 mg prednisolone i.v. during surgery. In four patients no steroids were given at all. On the 1st and 2nd postoperative day, the larynx was examined in a clinical setting. Five of six patients who received intraoperative steroid medication had no postoperative laryngeal edema. Only in one of those patients we examined a small edema of the arytenoid region. In all four patients without steroid medication a postoperative edema of the ipsilateral arytenoid hump was seen. Thus, intraoperative intravenous steroid administration seems to prevent, or at least reduce, postoperative laryngeal edema. Only in one of those patients we examined a small edema of the arytenoid region.

Die forcierte InspirationEin nützliches Kriterium zur Diagnostik des Reinke-Ödems?

AbstractDie Größenbeurteilung des Reinke-Ödems ist bei der klinischen Untersuchung trotz verbesserter endoskopischer Diagnoseverfahren bisweilen schwierig. Es stellt sich die Frage, wie der Untersucher eine Größeneinschätzung endoskopisch möglichst einfach durchführen kann. In unserer Abteilung wurden im Rahmen einer Untersuchung 42 Patienten mit Reinke-Ödem u. a. videolaryngoskopisch und -stroboskopisch untersucht. Dabei wurde die Größe des Stimmlippenödems bei Phonation, bei Ruherespiration und bei forcierter Inspiration beurteilt. Alle Aufnahmen wurden miteinander verglichen. Bei 18 Patienten (43%) zeigte sich das Ödem bei forcierter Inspiration größer als bei den anderen Untersuchungsschritten. Der bei der forcierten Inspiration auftretende aerodynamische Unterdruck bewirkt, dass das bewegliche, oberflächliche Stimmlippengewebe angesogen wird. Die forcierte Inspiration ist eine einfach durchzuführende Untersuchungstechnik, die das Erkennen und die Größenbeurteilung von Reinke-Ödemen präzisieren kann.

Erfahrungen mit der intraoperativen Prednisolongabe bei der Thyreoplastik Typ I nach Isshiki

Laryngeal edema is considered a postoperative problem in phonosurgery. In a prospective study we examined if a single intraoperative application of prednisolone can decrease the incidence of postoperative laryngeal edema after Isshiki type I thyroplasty. We examined ten patients undergoing unilateral type I thyroplasty [seven men and three women, age range: 19-60 years (average: 48 years)]. In six patients we administered 250 mg prednisolone i.v. during surgery. In four patients no steroids were given at all. On the 1st and 2nd postoperative day, the larynx was examined in a clinical setting. Five of six patients who received intraoperative steroid medication had no postoperative laryngeal edema. Only in one of those patients we examined a small edema of the arytenoid region. In all four patients without steroid medication a postoperative edema of the ipsilateral arytenoid hump was seen. Thus, intraoperative intravenous steroid administration seems to prevent, or at least reduce, postoperative laryngeal edema. Only in one of those patients we examined a small edema of the arytenoid region.

Erfahrungen mit der intraoperativen Prednisolongabe bei der Thyreoplastik Typ I nach Isshiki@@@Experiences with intraoperative application of prednisolon during Isshiki type I thyroplasty

Laryngeal edema is considered a postoperative problem in phonosurgery. In a prospective study we examined if a single intraoperative application of prednisolone can decrease the incidence of postoperative laryngeal edema after Isshiki type I thyroplasty. We examined ten patients undergoing unilateral type I thyroplasty [seven men and three women, age range: 19-60 years (average: 48 years)]. In six patients we administered 250 mg prednisolone i.v. during surgery. In four patients no steroids were given at all. On the 1st and 2nd postoperative day, the larynx was examined in a clinical setting. Five of six patients who received intraoperative steroid medication had no postoperative laryngeal edema. Only in one of those patients we examined a small edema of the arytenoid region. In all four patients without steroid medication a postoperative edema of the ipsilateral arytenoid hump was seen. Thus, intraoperative intravenous steroid administration seems to prevent, or at least reduce, postoperative laryngeal edema. Only in one of those patients we examined a small edema of the arytenoid region.

Reinke-Ödem : Hilfreich bei einseitiger Rekurrensparese?

ZusammenfassungWir berichten über eine 57-jährige Lehrerin, die uns aufgrund einer bekannten einseitigen Rekurrensparese nach vorangegangener Strumektomie vorgestellt wurde. Die videolaryngoskopische und -stroboskopische Untersuchung zeigte zusätzlich zur linksseitigen Rekurrensparese ein Reinke-Ödem bei guter Stimmfunktion. Aufgrund des linksseitigen Reinke-Ödems war der Glottisschluss vollständig möglich, obwohl die linke Stimmlippe schlaff und exkaviert still stand. Eine operative Abtragung des Stimmlippenödems würde in diesem Fall voraussichtlich zu einer deutlichen Verschlechterung der Stimmfunktion führen. Es konnte anhand dieses Beispiels gezeigt werden, dass in ausgewählten Fällen ein Reinke-Ödem dazu beitragen kann, bei einem einseitigen Stimmlippenstillstand die Stimmgebung zu erhalten. Die Indikationsstellung zur operativen Therapie sollte in diesen Fällen sehr restriktiv und immer unter Berücksichtigung der Stimmfunktion gestellt werden.AbstractWe report on a 57-year-old teacher who consulted us for her known unilateral recurrent nerve paralysis subsequent to strumectomy. Video laryngoscopic and stroboscopic examinations revealed Reinkes edema in addition to the left-sided immobile vocal fold with maintenance of good vocal function. Because of the left-sided Reinkes edema, complete glottal closure was possible although the left vocal ligament remained slack. Surgical removal of the vocal fold edema in this case would presumably result in considerable impairment of vocal function. This example illustrates that in selected cases Reinkes edema can contribute to maintenance of phonation in unilateral vocal fold paralysis. In these cases, indication for edema surgery should be very restrictive and should always take the vocal function into consideration.

Endoscopic assessment criteria in central laryngeal motility disturbances

Bei der Beschreibung von Bewegungsstörungen im Bereich des Kehlkopfes stehen in der Literatur meistens die peripheren Störungen des N. vagus im Vordergrund.Wichtig sind hingegen auch die endoskopischen Beurteilungskriterien bei zentralen Störungen des Larynx. Es zeigt sich, dass die erhobenen Befunde zentraler Läsionen teilweise erheblich von den bekannten endoskopischen Bildern bei peripheren Nervenläsionen differieren. Die Kenntnis darüber kann zu einer Erhöhung der diagnostischen Sicherheit bei der Beurteilung neurologisch bedingter Stimmstörungen beitragen.