Endoscopic characterization of vascular changes in Reinke's edema using the classification guideline of the European Laryngological Society.

Introduction Glottic vascular changes accompany the development of Reinke's edema. The European Laryngological Society (ELS) proposed 2016 a classification guideline that distinguishes between longitudinal and perpendicular vascular changes. The combination of white light endoscopy (WLE), Narrow Band Imaging (NBI) and contrast-enhanced contact endoscopy (CE-NBI) allows their detailed assessment.

Methods In the present study, 31 patients with Reinke's edema underwent intraoperative endoscopic assessment of the vocal fold vessels using WLE, NBI and CE-NBI. The visible vascular changes were classified in all three modalities according to the ELS guideline. 

Results Only longitudinal vascular changes could be identified using WLE. Vascular ectasia and change of direction in 100% of the cases, branching in 87.1%, meandering in 54.8%, increased vessel frequency in 41.9% and convolutes in 16.1%. The meander, convolute, increased frequency and branching were detected more frequently using NBI and CE-NBI than using WLE. Enlarged vessel loops could be identified in 9.7% and dot-like vessel loops in 3.2% of the cases using NBI-CE.

Conclusion Vascular changes in Reinke’s edema can be adequately classified using the ELS guideline, while NBI allows a more accurate characterization. The use of CE-NBI enables the identification of otherwise undetected perpendicular vascular changes. The different vascular changes and their prognostic and therapeutic relevance for Reinke’s edema need to be further investigated in the future.

Publication History

Article published online:
24 May 2022