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라인케씨 부종 환자에서 경윤상 갑상막 접근을 통한 성대 내 스테로이드 주입술의 효용

The Efficacy of Percutaneous Steroid Injection via Cricothyroid Membrane for Reinke’s Edema

대한후두음성언어의학회지 2019년 30권 2호 p.101 ~ 106
남우주 ( Nam Woo-Joo ) - 성균관대학교 의과대학 강북삼성병원 이비인후과학교실

김선우 ( Kim Sun-Woo ) - 성균관대학교 의과대학 강북삼성병원 이비인후과학교실
진성민 ( Jin Sung-Min ) - 성균관대학교 의과대학 강북삼성병원 이비인후과학교실
이상혁 ( Lee Sang-Hyuk ) - 성균관대학교 의과대학 강북삼성병원 이비인후과학교실

Abstract


Background and Objectives: Reinke’s edema is a benign vocal fold disease caused by an edematous laryngeal superficial layer of lamina propria. The first line treatment is cessation of smoking and laryngeal microsurgery. The aim of the study is to evaluate the feasibility and efficacy of percutaneous steroid injection via cricothyroid membrane in patients with Reinke’s edema.

Materials and Method: From Jan 2010 to July 2018, 33 Patients with Reinke’s edema managed by vocal fold steroid injection via the cricothyroid membrane were included in this study. We compared medical records of laryngoscopy, stroboscopy and Multi-Dimensional Voice Program analysis at pre-treatment and post-treatment. Subjective voice improvement was evaluated using Voice Handicap Index-30 (VHI-30).

Results: 75.7% of the patients showed partial response and 6.06% showed complete response. 93.94% were present smokers and only 4 patients ceased smoking after the treatment. In acoustic analysis, the pre-treatment mean value of jitter, shimmer, and noise to harmonic ratio was 2.30±3.21, 9.34±10.37, 1.11±2.90 each. The post-treatment value was 2.20±1.89, 6.96±5.30, 0.20±0.09 respectively and none of the parameters were statistically significant. For subjective symptom improvement, 25 (75.8%) patients showed a better score on post-treatment VHI-30 compared to pre-treatment.

Conclusion: According to our study, steroid injection is a relatively safe and effective procedure for patients with Reinke’s edema. A vocal fold steroid injection via the cricothyroid membrane can be an alternative treatment option for those who are not able to undergo conventional laryngeal microscopic surgery, however cessation of smoking is necessary for effective treatment.

키워드

성대; 레인케씨 부종; 경피적; 스테로이드 주입술; 치료
Vocal cords; Reinke’s edema; Percutaneous; Steroid injection; Treatment
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