Reinke's space is a critical laryngeal structure, and the eponym remains in current use in both clinical and research settings. However, little is known about the life of the German anatomist Friedrich Berthold Reinke. His name is missing from the otolaryngological histories, despite his work on the structure he described being responsible for a fundamental advance in our understanding of the larynx. Although brilliant, Reinke was described as impetuous and coarse by his colleagues, resulting in his academic career being cut short. Reinke's relative anonymity is thought to derive from the fact that he never defined himself as a laryngologist. Without question, Reinke's observations of the human vocal fold are substantive contributions, without which modern laryngology could not have evolved. This article aimed to summarise this brilliant yet troubled man's life and achievements, allowing appreciation for his singular genius and fundamental contribution to laryngology.

The authors report a first case of chronic motor axonal neuropathy involving ENT manifestations, in a 64-year-old male presenting with gait difficulties, effort dyspnoea and dysphonia. Eleven months after the first symptoms, he developed severe hypoventilation, limb weakness and bilateral vocal fold palsy and had to be intubated for respiratory failure. The diagnosis of chronic motor axonal neuropathy was suspected on clinical and electrophysiological grounds. The patient improved dramatically after a five-day course of 0.4 g/kg intravenous immunoglobulin. He is still being treated with methylprednisolone 0.5 mg/kg every other day and remains stable.

We conclude the bilateral vocal fold palsy may be associated with chronic motor axonal neuropathy and that the immunosuppressive treatment may be effective in such cases.

Laryngeal photographs from 165 Taiwanese subjects were taken during microlaryngoscopy. Photographs of the vocal fold during the open phase were chosen. For measuring the vocal fold length, both the photograph of a ruler and the larynx were taken under the operating microscope, thus forming a ‘new scale’. Photographs of the vocal fold and the ruler were then processed at the same power of magnification. The length of the vocal folds was measured with the ‘new scale’. In 100 patients receivingdirect laryngoscopy under neuroleptic anaesthesia, the vocal fold length was 14.6 ± 1.2 mm (n = 35) for males and 11.1 ± 1.0 mm (n = 65) for females. In 65 patients under general anaesthesia, the vocal fold length was 15.3 ± 1.6 mm (n = 23) for males and 13.5 ± 1.3 mm (n = 42) for females. Statistical analysis revealed a significant difference between both groups and both sexes. Elongation of the vocal fold under general rather than neuroleptic anaesthesia may be important when performing functional surgery of the vocal fold.

We present a rare presentation of myasthenia gravis as acute inspiratory stridor in a 16-year-old girl. Prompt diagnosis and medical treatment avoided the need for tracheostomy. Although an uncommon cause, myasthenia gravis should be included in the differential daignosis of stridor.

Laryngeal obstruction due to bilateral vocal fold paralysis has been treated in many different ways. The CO2 laser or KTP-532 laser endoscopic cordectomy described in this report is a slight modification of the posterior partial cordectomy proposed by Dennis and Kashima. This technique was used in 18 patients (14 with the CO2 and four with the KTP-532 laser). Prophylactic tracheostomy was performed preoperatively. Post-operative results were excellent in nine cases, good in seven cases and poor in two cases who had to remain with a permanent tracheostomy tube with a speaking valve. The main complications noted were the formation of a granuloma (seven cases) and arytenoid oedema (six cases). Revision surgery was performed in the seven cases with granuloma formation and in the two with persistent oedema. The results and the post-operative findings from the use of the two lasers were similar.

Caffeine is considered to be a dehydrating agent with detrimental effects on the quality of voice of persons ingesting it. This has led medical personnel dealing with voice disorders, especially in the case of professional voice users, to give advice against the use of caffeine. Yet this is an anecdotal truth as an extensive Medline literature search did not reveal any scientific evidence of caffeine being proven to have adverse effects on the vocal folds. We, therefore, initiated this pilot study to ascertain the connection between caffeine and voice quality on a laboratory basis. Two hundred and fifty mg of caffeine were provided to eight volunteers in tablet form, and blood levels along with laryngograph readings were recorded to document the changes produced. Analysing the irregularities of frequencies in a) free speech b) a reading passage and c) singing ‘Happy Birthday’, substantial changes were seen to authenticate the fact that caffeine does produce alterations in voice quality but these alterations have considerable intrasubject variability. A full study with wider parameters is to be performed on this subject as we consider it to be of importance in the management of voice disorders.

Sixty-one cases of bilateral immobile vocal folds were classified as traumatic (52.46 per cent), idiopathic (39.34 per cent) or iatrogenic (8.20 per cent). During follow-up the idiopathic group of patients had a better prognosis (p<O.O5) compared to the traumatic or iatrogenic group. A spontaneous recovery was seen in 58.33 per cent of cases in the idiopathic group, 56.25 per cent in the traumatic group and 40.0 per cent in the iatrogenic group within a period of one year. Patients who failed to show spontaneous recovery were either subjected to arytenoidectomy with fold lateralization, endoscopic fold lateralization or laser cordectomy, showing 70.0 per cent, 66.67 per cent and 80.0 per cent recovery respectively. These cases have been discussed.

We report a rare case of laryngeal myxoma in a 57-year-old Japanese man. Except for a five-year history of gradually progressive hoarseness, he had been in good health. Video-stroboscopic examination revealed a solid mass in the anterior third of the right vocal fold. Phonosurgery performed with a microscope showed that the mass was encapsulated and located between the epithelium and vocal fold ligaments of the right vocal fold. This hard, elastic mass which measured 7 mm in diameter, was diagnosed as a myxoma. Only three cases of myxoma of the larynx have been reported in the English literature, with only one other case involving the vocal fold.

Paradoxical vocal fold movement leads to marked inspiratory stridor with adduction of the vocal folds on inspiration. A patient is presented who illustrates some of the difficulties in diagnosis and management. A range of treatments were tried including tracheostomy, laser arytenoidectomy and vocal fold lateralization.

Thecase records and histology of 34 patients with vocal process granulomata were reviewed. The five patients presenting most recently with idiopathic vocal process granulomata were investigated by axial computerized tomography (CT). Increased density of the arytenoid cartilage on the side of the lesion was found in all five cases. It is suggested that this indicates cartilage ossification, secondary to periochondritis. This perichondritis, playing either a primary or a secondary role in granuloma development, may explain the annoying tendency of vocal fold granulomata to recur after excision.