57 A 72-year-old woman presents with a history of hoarseness for 20 years that has been progressively getting worse in the last 6 months. She notes that the main changes in her voice include vocal fatigue and a decrease in pitch. She has no odynophonia, no dysphagia, and no odynophagia. She does report having increased shortness of breath for the past 6 months; initially she noted this on exertion only but now reports that she is constantly short of breath. On further questioning, she admits that the shortness of breath is the main reason she came into the clinic. She admits to smoking two packs a day for 50 years. She is a social drinker. She is not taking any medicines and has no cardiac, pulmonary, or neurologic history. On physical examination, she has audible inspiratory stridor. Fiberoptic examination shows her vocal folds when she inspires (Fig. 57.1) and when she expires (Fig. 57.2). On video stroboscopy, the vocal folds are seen to have generalized pale edema (best seen in Fig. 57.2) with some submucosal hypervascularity (best seen in Fig. 57.1). No discrete masses or lesions are appreciated. The mucosal waves are irregular and the mucosa appears to be very floppy. Fig. 57.1 Vocal folds during inspiration. Fig. 57.2 Vocal folds during expiration. 1.
Reinke Edema
History
Differential Diagnosis—Key Points
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