Hyaluronan in Human Vocal Folds in Smokers and Nonsmokers—A Histochemical Study

Abstract

Summary Objectives/hypothesisTo study the hyaluronan occurrence in human vocal folds, with special regards to gender and smoking and to discuss the implications of findings. Study DesignThis is a descriptive/morphologic study. MethodsSixteen cadaveric vocal folds from eight individuals between 58 and 90 years old (six women and two men) were removed and studied morphologically. Three of the individuals had been cigarette smokers.A direct method for hyaluronan histochemistry using a hyaluronan-binding protein probe (HABP) was used to visualize the polysaccharide. Five examiners performed an analysis of the intensities of hyaluronan staining, independently. ResultsWe observed intense hyaluronan staining of the vocal folds of which those from women stained considerably stronger than those from men. Stratified squamous epithelium stained for hyaluronan in all sections, whereas respiratory epithelium only stained weakly or not at all. The highest accumulation of hyaluronan occurred subepithelially in the lamina propria, corresponding to Reinke's space. It was observed that vocal folds from smokers were more intensively stained than those from nonsmokers. 2 ConclusionsHyaluronan is found in all layers of the human vocal fold. Contradictory to earlier studies, hyaluronan was visualized in squamous epithelium, where it may function as an impact protector. The occurrence of hyaluronan in smokers may have implications in the development of vocal fold inflammation and tumor initiation as hyaluronan is an important molecule in these processes.

Hyaluronan in vocal folds and false vocal folds in patients with recurrent respiratory papillomatosis

“…The authors were blinded during evaluation. In the HA slides, staining intensity was scored in the epithelium, stroma and papilloma tissue using a modified grading scale by Opheim et al [10] designed to semiquantify the HA staining intensities with grading 0: no staining, 1: faint staining and 2: intense staining. In the CD44 slides, two parameters were evaluated for epithelium, stroma and RRP lesions respectively: The first was presence of CD44 (0: no stain, 1: visible staining) and the second congruence with HA staining (plus (þ): congruence, minus (À): no congruence).…”

“…In human VF, only a few reports on the occurrence and distribution of HA are available [4,10]. In these reports, materials and methods differ, the small sample sizes affect the reliability of the study outcome, and the findings have been contradictory.…”

Hyaluronic Acid Concentration in Female Vocal Folds With Reinke’s Edema

“…A study of 8 cadavers (6 female and 2 male, 3 smokers) found greater amounts of HA in the vocal folds of smokers than nonsmokers. However, this was performed by staining tissue samples, a method that does not quantify HA 20 . RE is characterized by increased tissue viscosity and volume, and both biomechanical properties are related to the presence of HA in the vocal folds 5 .…”

“…However, this was performed by staining tissue samples, a method that does not quantify HA. 20 RE is characterized by increased tissue viscosity and volume, and both biomechanical properties are related to the presence of HA in the vocal folds. 5 Therefore, RE might be related to an increased concentration of the HA component of the extracellular matrix.…”