title: Are Vocal Alterations Caused by Smoking in Reinke's Edema in Women Entirely Reversible After Microsurgery and Smoking Cessation?
abstract: BACKGROUND
  Reinke's edema is a benign lesion of the vocal folds that affects chronic smokers, especially women. The voice becomes hoarse and virilized, and the treatment is microsurgery. However, even after surgery and smoking cessation, many patients remain with a deep and hoarse voice.
  
  
  OBJECTIVE
  The aim of the present study was to compare pre- and postoperative acoustic and perceptual-auditory vocal analyses of women with Reinke's edema and of women in the control group, who were non-smokers.
  
  
  METHODS
  A total of 20 women with videolaryngoscopy diagnosis of Reinke's edema who underwent laryngeal microsurgery were evaluated pre- and postoperatively (6 months) by videolaryngoscopy, acoustic voice, and perceptual-auditory analyses (General degree of dysphonia, Roughness, Breathiness, Asthenia, Strain, and Instability [GRBASI] scale), and the maximum phonation times were calculated. The pre- and postoperative parameters of the women with Reinke's edema were compared with those of the control group of women with no laryngeal lesions, smoking habit, or vocal symptoms.
  
  
  RESULTS
  Acoustic vocal perceptual-auditory analyses and the maximum phonation time of women with Reinke's edema improved significantly in the postoperative evaluations; nevertheless, 6 months after surgery, their voices became worse than the voices of the women from the control group.
  
  
  CONCLUSIONS
  Abnormalities caused by smoking in Reinke's edema in women are not fully reversible with surgery and smoking cessation. One explanation would be the presence of possible structural alterations in fibroblasts caused by the toxicity of cigarette components, resulting in the uncontrolled production of fibrous matrix in the lamina propria, and preventing complete vocal recovery.
authors.affiliation: Discipline of Otolaryngology, UNESP Universidade Estadual Paulista, Botucatu, São Paulo, Brazil. Electronic address: rmartins@fmb.unesp.br.
authors.forename: Regina Helena Garcia
authors.initials: RHG
authors.lastname: Martins
authors.affiliation: Speech Therapy, Discipline of Otolaryngology, UNESP Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Elaine Lara Mendes
authors.initials: ELM
authors.lastname: Tavares
authors.affiliation: Speech Therapy, Discipline of Otolaryngology, UNESP Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Adriana Bueno Benito
authors.initials: ABB
authors.lastname: Pessin
mesh_terms: D000162:Acoustics; D000328:Adult; D000368:Aged; D001307:Auditory Perception; D016022:Case-Control Studies; D004487:Edema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007600:Judgment; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007828:Laryngoscopy / Q000379:methods; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects; D010699:Phonation; D020127:Recovery of Function; D012907:Smoking / Q000009:adverse effects* / Q000503:physiopathology; D013061:Speech Acoustics; D013997:Time Factors; D016896:Treatment Outcome; D014741:Video Recording; D014827:Vocal Cords / Q000503:physiopathology / Q000601:surgery*; D014832:Voice Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014833:Voice Quality
keywords: Reinke's edema; dysphonia; microsurgery; smoking; voice