Reinke’s Edema - Types, Causes, Symptoms, and Treatment

Introduction:

Reinke’s edema refers to the swelling of vocal cords due to the filling of fluid in Reinke’s space. It is a layer of the vocal fold that plays its role in sound production. Reinke’s edema is the polypoid degeneration of one or both vocal folds within Reinke’s space. A voice disorder can occur due to swelling of the non-muscle part of the vocal fold that is right underneath its surface lining (Reinke’s space). The primary risk factor for Reinke’s edema is tobacco use. It is also called smoker’s polyps of the vocal cords or polypoid corditis. It is most commonly seen in middle-aged post-menopausal women with long-term smoking histories. As a result, the vocal cords develop more mass, vibrating slower while speaking. This leads to a deeper voice, usually in women, where they are presented with higher pitches than men.

What Is Reinke’s Space?

It refers to the layer or space just underneath the surface lining of the vocal fold. It consists of cells, special fibers, and other substances, such as an extracellular matrix. It plays a vital role in vocal fold vibration.

What Are the Causes of Reinke’s Edema?

Various causes are involved, and these include:

• Smoking is the primary cause.

• Laryngopharyngeal reflux (backflow of stomach acids to the voice box).

• Vocal fold irritation from voice overuse.

• Conditions that irritate vocal folds.

• Hypothyroidism.

• Hormonal change.

• In addition, individuals in professions that require constant use of voice, such as teachers, singers, and radio hosts, are at higher risk of developing this condition.

What Are the Symptoms of Reinke’s Edema?

The symptoms of Reinke’s edema include:

• Hoarseness and deepening of the voice.

• Dysphonia (trouble speaking).

• Dyspnea (shortness of breath).

• The sac-like appearance of the vocal folds.

• Rough voice.

• Vocal fatigue.

• Loss of voice brilliance.

• Voice tires usually at the end of the day.

The following are the less common symptoms of Reinke’s edema:

• Stridor.

• Noisy breathing.

• Discomfort while swinging or talking.

• Pain or tightness in the neck.

• Difficulty in speaking softly.

• Voice pitch contraction.

• Difficulty singing on the high notes.

What Are the Other Findings Present in Patients With Reinke’s Edema?

• The change in voice cannot be changed overnight. Since Reinke’s edema develops gradually, the voice change can only be noticed after years.

• Reinke’s edema can be noticed commonly in middle-aged groups of patients around 40 to 60 years. A newly diagnosed patient complains of experiencing the build-up of gelatinous fluid within the vocal folds for many years since it is a slowly progressive condition.

• It is most commonly seen in middle-aged post-menopausal women. However, since not many cases are identified, the true incidence of the condition is unknown, and the reports suggest that the occurrence could be equal for both men and women.

• A low-pitched voice is easily noticeable in women, and this condition can be easily identified simply because a low voice is unusual in females. As a result, healthcare professionals believe that women report more cases of Reinke’s edema, even if an equal number of men develop the condition because of the inability to differentiate voices.

• More women than men with Reinke’s edema seek medical care because they sound like a man’s voice.

• In severe cases, Reinke’s edema can progress to enlarged vocal folds, which causes narrowing of the airway, resulting in breathing difficulty. At this stage, breathing can be noisy and need increased effort, particularly during exercise.

What Are the Types of Reinke’s Edema?

Reinke's edema is classified based on its morphological characteristics based on the one or two vocal folds involved and the presence or absence of polypoid lesions. It is grouped into four types, and these include:

• Type 1 - Reinke’s edema with one vocal cord.
• Type 2 - Reinke’s edema of both vocal cords.
• Type 3 - Reinke’s edema of one vocal fold is associated with a polypoid lesion (not necessarily on the same fold of the edema).
• Type 4 - Reinke’s edema of both vocal folds with associated polypoid lesions on one or both folds).

What Are the Risk Factors of Reinke’s Edema?

The factors that worsen the risk for Reinke's edema include:

• Long-term exposure to smoking, reflux to the voice box, and vocal abuse: The chronic irritation of vocal folds due to smoking cigarettes causes voice disorders. Chronic exposure develops a certain degree of Reinke’s edema. This may result in a condition called smoker’s voice - the raspy, low-pitched voice.

• Based on the severity of the gastroesophageal reflux, the worse the reflux increases the risk of developing voice disorders such as Reinke’s edema.

• Based on the combination or number of risk factors present: The presence of one or more risk factors and the combined effect of these factors increases the risk of developing voice disorders.

• Genetic, hormonal, and behavioral factors also influence the risk of developing this condition.

• Some allergies are responsible for developing Reinke’s edema.

What Are the Treatment Approaches for Reinke’s Edema?

The causes of Reinke’s edema need to be ruled out and treated accordingly to achieve a positive outcome. Long-term prognosis and success depend on two strategies, such as:

• Identifying and Fixing the Underlying Cause: Smoking, treating reflux, and avoiding voice overuse or misuse. The initial aim of the treatment is to quit smoking. Early or mild cases of Reinke’s edema can show tremendous improvement with the cessation of smoking alone. Laryngologists prefer the commencement of treatment after smoking cessation.

• Voice Therapy: In a few cases, vocal fold phonomicrosurgery is carried out to aid in voice improvement.

• Microlaryngoscopic Surgery: It is the main treatment option if the patient fails to improve the condition even after smoking cessation. In this procedure, the superficial lamina propria must be reduced but not in excess to preserve the vibration of the fold. Excess reduction produces hoarseness and scarring, which is very difficult to manage. The surgery always aids in improving the voice gradually and eliminates breathing difficulty.

• Stripping: A surgical procedure that removes the superficial layer of the vocal fold results in scarring and abnormal voice. Due to the risk of damage, this procedure is rarely used.

Conclusion:

Reinke’s edema is a benign voice condition that may rarely result in life-threatening conditions. In some cases, voice therapy with efficient techniques is followed to reduce the symptoms, including vocal tiredness. But the voice therapy techniques alone will not eliminate the fluid build-up, which is the characteristic feature of Reinke’s edema.