What is Reinke Edema?
Reinke edema is a non-dangerous condition that causes swelling in the vocal folds, the skin-like structures in your throat that vibrate to produce sound. This happens in a deeper part of the vocal fold called the ‘Reinke space’. The condition is also called polypoid corditis or polypoid laryngitis, which refers to the formation of a polyp-like swelling in the superficial layer of the lamina propria, an area within the Reinke space. This phenomena can be seen under microscope in severe cases.
Smoking, strains to the vocal cord such as yelling or screaming (phonotrauma), and a type of acid reflux affecting the throat (laryngopharyngeal reflux) are all risk factors associated with Reinke edema, with smoking being considered the most harmful.
This condition is clinically important as it can cause significant voice changes, particularly in women, and typically results in a deeper voice. In severe cases, it can also obstruct the airway. Lifestyle changes, like quitting smoking, are often suggested as a first treatment step for less severe cases of Reinke edema. However, for greater severity, numerous other treatment methods are available. Recent studies are investigating the effectiveness of simple in-office procedures compared to traditional surgeries using a small, lighted tube (microlaryngoscopy).
Overall, while Reinke edema isn’t life-threatening, it can still greatly affect a person’s quality of life. As it’s a rare condition, treatment options can drastically differ, hence, studies are ongoing to establish the best strategies for managing this condition.
What Causes Reinke Edema?
Reinke’s edema is a condition that could develop due to several factors. These include smoking, phonotrauma (damage to the vocal cords from misuse or overuse), and laryngopharyngeal reflux (a condition wherein stomach contents come up into the throat causing symptoms and damage). Out of these, smoking is the most significant cause. Long-term exposure to cigarette smoke can not only lead to the development of this condition but can also cause it to come back if it has been treated before.
Risk Factors and Frequency for Reinke Edema
Reinke edema is a condition that mostly occurs in people between 50 and 60 years of age. Up to 80% of patients are female, with nearly half being between 40 and 59 years old. Though it’s not clear why Reinke edema is more common in women, there are a few theories.
- Women may be more aware of changes in their voice and thus more likely to seek medical help.
- Naturally higher levels of hyaluronic acid (a substance found in the vocal folds) in women may play a role. Patients with Reinke edema tend to have higher levels of this acid than those without the condition.
- Tobacco smoke can increase the production of hyaluronic acid. Given this, it’s possible that higher levels of hyaluronic acid contribute to the development of Reinke edema, but more research is needed to confirm this.
Signs and Symptoms of Reinke Edema
Reinke Edema is a rare condition that mainly causes changes in a person’s voice, including the quality, pitch, loudness, or the effort required to speak. As the condition progresses, affected individuals often experience their voice deepening along with some hoarseness. However, to adequately diagnose Reinke Edema, a thorough assessment of the patient’s medical history is critical.
The factors medical professionals usually consider include:
- How long the vocal changes have been occurring
- When the changes started
- Any events that may have triggered these symptoms
- Additional symptoms like swallowing difficulties, breathing issues, throat or ear pain, or coughing up blood
- General symptoms like fever or weight loss
- How it affects daily life
- Any factors that improve or worsen the symptoms
- Patient’s general medical history
- Lifestyle factors like smoking and alcohol use
- Current medications
- Any surgeries or instances when a breathing tube had been inserted
- History of radiation treatments
A physical examination of the head and neck, with a focus on the mouth, throat, neck, thyroid gland, nasal passage, and the person’s voice quality is also part of the diagnosis process. However, in cases where Reinke Edema is causing the voice problems, the examination typically does not reveal any significant findings apart from the voice changes.
After the detailed history and physical examination, medical professionals would determine if there is a need to refer the patient to a specialist, such as an ENT (ear, nose, and throat) doctor who can do a more specialized examination called a diagnostic laryngoscopy.
Patient referrals are highly recommended if the voice changes have been present for more than four weeks, or if the patient has undergone a recent surgical procedure in the head, neck, or chest area, has a history of smoking, or uses their voice professionally (like singers or actors). Furthermore, if the medical professional suspects a severe underlying cause, a diagnostic laryngoscopy is also advised.
As Reinke Edema often leaves patients with long-lasting voice changes and is typically seen in individuals with a history of smoking, a diagnostic laryngoscopy is a crucial part of the evaluation process.
Testing for Reinke Edema
If the doctor suspects that you may have a condition called Reinke edema, they will use a few different methods to confirm the diagnosis. The first step usually involves a special examination of your voice box, or larynx, using laryngoscopy. This is typically done in the doctor’s office with a tool called a flexible fiberoptic endoscope, which helps the doctor see inside your throat.
Reinke edema is rare, but if you have symptoms like a hoarse voice and you have a history of heavy smoking, the doctor will want to examine your larynx to check for any possible cancerous growths. If you do have Reinke edema, the doctor will see a balloon-like swelling on your vocal cords during the laryngoscopy.
There are several categories of Reinke edema, with a classification system recently proposed by de Vincentiis and his colleagues. This system includes four types of Reinke edema:
* Type 1: Only one vocal cord is affected
* Type 2: Both vocal cords are affected
* Type 3: One vocal cord is affected and there’s a growth on either cord
* Type 4: Both vocal cords are affected and there’s a growth on one or both cords
Another technique used by ear, nose, and throat specialists is called videostroboscopy. This technique helps the doctor understand if there’s any imbalance and measure the degree of movement and changes in the vocal cords.
In addition to these examinations, your doctor will also listen to your voice to assess its quality. They will use something called the GRBAS scale, which rates the grade, roughness, breathiness, weakness, and strain of your voice. For each category, your doctor will assign a rating from 0 to 3; 0 means no deficit, and 3 represents a severe deficit. This helps to monitor changes in your voice over time and before and after any treatment.
Another similar tool your doctor might use is the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). This tool also measures elements of your voice while you perform certain tasks, like reading aloud. Using the CAPE-V, the doctor can track any improvements or worsening of your voice over time.
Lastly, the doctor may ask you to complete a questionnaire, like the Voice Handicap Index-10 (VHI-10), to determine if your voice issue is affecting your everyday life. This tool not only helps the doctor to understand your perspective but also helps to track the progression of your condition over time.
Treatment Options for Reinke Edema
Reinke edema is a rare condition that can cause voice issues or hoarseness. While the disease might alter the appearance of the voice box or larynx area, successful treatment focuses more on restoring and improving the quality of the voice rather than the way it looks. Because Reinke edema is relatively rare, treatment choices often depend on the healthcare provider’s training and the resources available. Treatments can be done in a doctor’s office or in an operating room. Additionally, aiding measures, like speech therapy or quitting smoking, can play a crucial role in getting and keeping better results.
The treatment options include cold steel excision, CO2 laser, microdebridement, photoangiolytic laser, and intralesional injection. Let’s break down what each procedure involves:
Cold Steel Excision: In this operation, the patient is placed under a scopic procedure in the operating room. The larynx is visually examined using an operating microscope or endoscope. Using a “cold” or not heated instrument, an incision is made, and the swollen superficial layer is removed. After enough of the swollen area has been removed, the remaining tissue is left to heal naturally.
Microdebridement: This technique is similar to cold steel excision. An instrument known as a microdebrider is introduced to remove the excess swollen tissue. The remaining tissue is left to heal naturally.
Laser Therapy: Special lasers can be used either in a doctor’s office or in an operating room. The CO2 laser technique is similar to cold steel excision, but the laser is used to make the incision. Lasers like the potassium titanyl phosphate (KTP) laser, thulium fiber laser (TFL), pulsed dye laser (PDL), and a blue-light diode laser have all been found effective in treating Reinke edema in-office. However, the ability to use these treatments will depend on the patient’s comfort level and the accessibility of certain areas in the voice box.
Intralesional Injection: This treatment involves injections directly into the swollen tissue. In one study, an injection of a medication called triamcinolone resulted in improved voice function. Another study found injections of a substance called hyaluronidase led to reduced swelling, and the patients did not require any additional procedures.
What else can Reinke Edema be?
Reinke edema is a condition that can cause changes in the voice, also known as dysphonia. When trying to diagnose this condition, doctors need to consider various possible causes which can lead to similar symptoms. This could range from nerve problems, infections, and inflammation, to cancer, birth defects, injuries, and behavioral issues.
However, there are certain conditions that are more likely to be confused with Reinke edema. These include:
- Acute and chronic laryngitis, which is inflammation of the voice box
- Benign and malignant tumors, such as papilloma or squamous cell carcinoma
- Vocal cord weakness or paralysis that can affect one or both vocal cords
- Presbyphonia, which is voice changes due to aging
- Damage to the vocal folds from overuse, leading conditions like vocal fold nodules or hemorrhagic polyps
- Functional dysphonia, such as muscle tension dysphonia, which is caused by improper use of the voice muscles
Even though Reinke edema is a relatively rare and non-cancerous condition, it is important for doctors to be thorough in their examination and not rush to a diagnosis based purely on the patient’s symptoms.
What to expect with Reinke Edema
People with Reinke edema, a swelling of the vocal cords, generally have a positive outlook. This condition naturally isn’t dangerous, but it’s often caused by smoking, which is known to increase the risk of throat cancer. That said, it’s quite rare for Reinke edema to occur at the same time as cancerous or precancerous cells in the throat, and there aren’t many reports of people having both conditions at the same time.
There are various treatments for the voice problems caused by Reinke edema, and results can vary. Further studies are needed to establish the best treatments, and what kind of results patients can expect.
Possible Complications When Diagnosed with Reinke Edema
Reinke edema can lead to serious complications, mostly related to the chance that it could block the airway. If someone already has Reinke edema, it can make it more difficult to remove a breathing tube or use positive pressure ventilation, a tool commonly used for respiratory failure, due to swelling of the larynx. This edema can also narrow the opening of the vocal cords and make it harder to insert a breathing tube.
Healthcare providers should be extra careful when handling the airway of a patient suspected of having, or who has been diagnosed with, Reinke edema. They should always err on the side of caution and be proactive with managing the airway. Severe Reinke edema might make patients prone to postobstructive pulmonary edema, which can occur after a block in the airways, after surgery. Careful oversight and monitoring are critical to successfully managing the airway in these patients.
Potential issues related to Reinke Edema:
- Blocked airway
- Difficulty in removing a breathing tube
- Challenges with positive pressure ventilation
- Narrowing in the opening of the vocal cords, making intubation challenging
- Potential for postobstructive pulmonary edema after surgery
Preventing Reinke Edema
Reinke edema, a condition linked to a history of smoking, can be mostly prevented by not smoking. Although stopping smoking after the condition has developed often can’t cure Reinke edema, it’s a crucial step in preventing the disease from coming back after surgery. It’s very important that patients understand the significance of quitting smoking.
