title: Hyaluronan in Human Vocal Folds in Smokers and Nonsmokers-A Histochemical Study.
abstract: OBJECTIVE
  To study the hyaluronan occurrence in human vocal folds, with special regards to gender and smoking and to discuss the implications of findings.
  
  
  METHODS
  This is a descriptive/morphologic study.
  
  
  METHODS
  Sixteen cadaveric vocal folds from eight individuals between 58 and 90 years old (six women and two men) were removed and studied morphologically. Three of the individuals had been cigarette smokers. A direct method for hyaluronan histochemistry using a hyaluronan-binding protein probe (HABP) was used to visualize the polysaccharide. Five examiners performed an analysis of the intensities of hyaluronan staining, independently.
  
  
  RESULTS
  We observed intense hyaluronan staining of the vocal folds of which those from women stained considerably stronger than those from men. Stratified squamous epithelium stained for hyaluronan in all sections, whereas respiratory epithelium only stained weakly or not at all. The highest accumulation of hyaluronan occurred subepithelially in the lamina propria, corresponding to Reinke's space. It was observed that vocal folds from smokers were more intensively stained than those from nonsmokers.
  
  
  CONCLUSIONS
  Hyaluronan is found in all layers of the human vocal fold. Contradictory to earlier studies, hyaluronan was visualized in squamous epithelium, where it may function as an impact protector. The occurrence of hyaluronan in smokers may have implications in the development of vocal fold inflammation and tumor initiation as hyaluronan is an important molecule in these processes.
authors.affiliation: Department of Otorhinolaryngology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Leif Runar
authors.initials: LR
authors.lastname: Opheim
authors.affiliation: Department of Public Health and Clinical Medicine, University Hospital of Umeå, Umeå, Sweden.
authors.forename: Urban
authors.initials: U
authors.lastname: Hellman
authors.affiliation: Department of Public Health and Clinical Medicine, University Hospital of Umeå, Umeå, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Engström-Laurent
authors.affiliation: ENT-unit, Department of Clinical Science, University of Umeå, Umeå, Sweden and the Department of Speech/Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa. Electronic address: claude.laurent@umu.se.
authors.forename: Claude
authors.initials: C
authors.lastname: Laurent
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D016022:Case-Control Studies; D004847:Epithelial Cells / Q000737:chemistry* / Q000473:pathology; D005260:Female; D006651:Histocytochemistry / Q000379:methods*; D006801:Humans; D006820:Hyaluronic Acid / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000378:metabolism* / Q000473:pathology; D013194:Staining and Labeling; D015854:Up-Regulation; D014827:Vocal Cords / Q000737:chemistry* / Q000473:pathology
chemical_list: D006820:Hyaluronic Acid
keywords: Cigarette; Histochemistry; Hyaluronan; Smoking; Vocal folds