Unsedated Office-Based Blue Laser Therapy in Female Patients With Reinke's Edema: A Retrospective Review of 8 Cases

  • Anthony Ghanem
    Department of Otorhinolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
    Search for articles by this author
  • Abdul Latif Hamdan
    Address correspondence and reprint requests to Abdul Latif Hamdan, American University of Beirut Medical Center, Bliss Street, P.O. Box 11-0236, Beirut, Lebanon.
    Department of Otorhinolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
    Search for articles by this author
Published:October 08, 2022DOI:



      To report on the outcomes of unsedated blue laser therapy in female patients with Reinke's edema.

      Study Design

      Retrospective chart review.


      A retrospective chart review of female patients undergoing unsedated office-based blue laser treatment of Reinke's edema between February 2020 and March 2022 at the Hamdan Voice and Swallowing Unit at the American University of Beirut Medical Center in Beirut, was conducted. Patients were assessed before and after the procedure with a follow-up interval of 3–6 weeks. Demographic data included age, history of smoking and grade of Reinke's edema. Voice outcome measures included the Voice Handicap Index-10 questionnaire, perceptual evaluation (GRBAS scale), acoustic analysis and maximum phonation time. Vocal fold lesions were evaluated using indirect laryngeal endoscopy.


      A total of eight patients were reviewed. The mean age was 59.63 ± 7.98 years. One patient was lost to follow-up. We report on a total of 10 Reinke's edema lesions treated with the blue laser. There was a significant decrease in the mean VHI-10 score (14.86 ± 5.84–6.71 ± 7.32; P < 0.01) as well as in the means of three perceptual evaluation parameters (G, R, B; P < 0.05). There was also a nonstatistically significant increase in the mean fundamental frequency and habitual pitch. Laryngeal examination showed complete regression in 50% of the lesions, and partial regression in the remaining 50%.


      Office-based blue laser treatment of Reinke's edema under local anesthesia can be considered an effective treatment modality as evidenced by improvement in post-procedure voice outcome measures.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pitman MJ
        • Lebowitz-Cooper A
        • Iacob C
        • et al.
        Effect of the 532nm pulsed KTP laser in the treatment of Reinke’s edema.
        The Laryngoscope. 2012; 122: 2786-2792
        • Druck Sant'Anna G
        • Mauri M
        Use of the microdebrider for Reinke's edema surgery.
        The Laryngoscope. 2000; 110: 2114-2116
        • Sato K
        • Hirano M
        • Nakashima T.
        Electron microscopic and immunohistochemical investigation of Reinke’s edema.
        Ann Otol, Rhinol Laryngol. Nov 1999; 108: 1068-1072
        • Hantzakos A
        • Remacle M
        • Dikkers F
        • et al.
        Exudative lesions of Reinke’s space: a terminology proposal.
        Eur arch oto-rhino-laryngol. 2009; 266: 869-878
        • Hah JH
        • Sim S
        • SY An
        • et al.
        Evaluation of the prevalence of and factors associated with laryngeal diseases among the general population.
        The Laryngoscope. 2015; 125: 2536-2542
        • Goswami S
        • Patra TK.
        A Clinico-pathological study of Reinke’s oedema.
        Indian J otolaryngol Head and Neck surg. 2003; 55: 160-165
        • Tavaluc R
        • Tan-Geller M
        Reinke’s edema.
        Otolaryngol Clin N Am. 2019; 52: 627-635
        • Hamdan A-L
        • Khalifee E
        • Abi Akl PR
        • et al.
        Pathogenic role of Reinke’s edema in snoring and obstructive sleep apnea.
        J Voice. 2020; 34: 456-459
        • Dewan K
        • Chhetri DK
        • Hoffman H
        Reinke’s edema management and voice outcomes.
        Laryngoscope Investigative Otolaryngol. 2022; 7: 1042-1050
        • Zeitels SM
        • Bunting GW
        • Hillman RE
        • et al.
        Reinke’s edema: phonatory mechanisms and management strategies.
        Ann Otol, Rhinol Laryngol. 1997; 106: 533-543
      1. Cummings CW. Otolaryngology–head & Neck Surgery: pt. 1. General considerations in head and neck. pt. 2. Face (1 v.). vol 1. Mosby year book; 1998.

        • Courey MS
        • Stone RE
        • Gardner GM
        • et al.
        Endoscopic vocal fold microflap: a three-year experience.
        Ann Otol, Rhinol Laryngol. 1995; 104: 267-273
        • Shoffel-Havakuk H
        • Sadoughi B
        • Sulica L
        • et al.
        In-office procedures for the treatment of benign vocal fold lesions in the awake patient: a contemporary review.
        The Laryngoscope. 2019; 129: 2131-2138
        • Woo P.
        Hyaluronidase injection in the vocal folds for vocal hemorrhage, Reinke edema, and hyaluronic acid overinjection: a novel application in the larynx.
        J Voice. 2018; 32: 492-498
        • Hamdan AL
        • Ghanem A.
        Un-sedated office-based application of blue laser in vocal fold lesions.
        J Voice. 2021;
        • Yonekawa H.
        A clinical study of Reinke’s edema.
        Auris Nasus Larynx. 1988; 15: 57-78
        • Rosen CA
        • Lee AS
        • Osborne J
        • et al.
        Development and validation of the voice handicap index-10.
        The Laryngoscope. 2004; 114: 1549-1556
        • Hirano M.
        Psycho-acoustic evaluation of voice.
        Clin examination of voice. 1981; : 81-84
        • Koszewski IJ
        • Hoffman MR
        • Young WG
        • et al.
        Office-based photoangiolytic laser treatment of Reinke’s edema: safety and voice outcomes.
        Otolaryngol–Head and Neck Surg. 2015; 152: 1075-1081
        • Mallur PS
        • Tajudeen BA
        • Aaronson N
        • et al.
        Quantification of benign lesion regression as a function of 532-nm pulsed potassium titanyl phosphate laser parameter selection.
        The Laryngoscope. 2011; 121: 590-595
        • Koufman JA
        • Rees CJ
        • Frazier WD
        • et al.
        Office-based laryngeal laser surgery: a review of 443 cases using three wavelengths.
        Otolaryngol—Head and Neck Surg. 2007; 137: 146-151
        • Hu H-C
        • Lin S-Y
        • Hung Y-T
        • et al.
        Feasibility and associated limitations of office-based laryngeal surgery using carbon dioxide lasers.
        JAMA Otolaryngol–Head & Neck Surg. 2017; 143: 485-491
        • Hamdan A-L
        • Ghanem A
        • Abi Akl PR
        • et al.
        Unsedated office-based thulium laser therapy in patients with Reinke’s Edema.
        J Voice. 2020; 36: 134-139
        • Hess MM
        • Fleischer S
        • Ernstberger M.
        New 445 nm blue laser for laryngeal surgery combines photoangiolytic and cutting properties.
        Eur Arch Oto-Rhino-Laryngol. 2018; 275: 1557-1567
        • Miller BJ
        • Abdelhamid A
        • Karagama Y.
        Applications of office-based 445 nm blue laser transnasal flexible laser surgery: a case series and review of practice.
        Ear, Nose & Throat J. 2021; 100: 105S-112S
        • Balouch B
        • Ranjbar PA
        • Alnouri G
        • et al.
        Surgical outcome of low-power-density blue laser for vascular lesions of the vocal fold.
        J Voice. 2022; (In press)