FRCS (ORL-HNS) · SECTION 1 SBA

Reinke oedema

A smoker has a very low-pitched voice and bilateral translucent polypoid swelling along the membranous vocal folds. What is the best management principle?

CHOOSE ONE ANSWER

Best of five

  1. A. Bilateral vocal-fold stripping to ligament
  2. B. Radiotherapy
  3. C. Antibiotics indefinitely
  4. D. Smoking cessation and voice optimisation, with conservative microlaryngeal surgery when symptoms justify it
  5. E. Ignore airway symptoms
ANSWER AND REASONING

D. Smoking cessation and voice optimisation, with conservative microlaryngeal surgery when symptoms justify it

Reinke oedema reflects superficial lamina propria change. Risk-factor control and careful tissue-preserving surgery aim to improve vibration; aggressive stripping causes scarring.

Why every option is right or wrong

A. Bilateral vocal-fold stripping to ligament: This destroys the layered vibratory cover.

B. Radiotherapy: The appearance is benign and radiation is inappropriate.

C. Antibiotics indefinitely: There is no bacterial infection.

D. Smoking cessation and voice optimisation, with conservative microlaryngeal surgery when symptoms justify it: Reinke oedema reflects superficial lamina propria change. Risk-factor control and careful tissue-preserving surgery aim to improve vibration; aggressive stripping causes scarring.

E. Ignore airway symptoms: Very bulky bilateral disease can narrow the glottis and alter anaesthetic planning.

What if the scenario changed?

If a focal irregular lesion or impaired mucosal wave raised concern for dysplasia, targeted biopsy would be required.

EDUCATIONAL USE

Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.

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