What is Reinke’s edema?
Reinke’s edema, also called ‘polypoid corditis,’ is a swelling of the entire layer of the superficial lamina propria (or Reinke’s layer), a structure crucial to normal voice function. It occurs exclusively in smokers, and some have proposed that it is a reaction to repeated exposure of the vocal folds to the heat of inhaled cigarette smoke.
Figure 1: Reinke’s edema involves the vocal fold on the left of the image, making it appear very swollen.
Reinke’s edema is not itself a pre-cancerous lesion, but it is a sign that the vocal cords have been exposed to a damaging degree of smoking. The entire surface of the mouth, the nose and the throat should be carefully examined in people with Reinke’s edema to make sure no cancer or precancerous lesions have been overlooked.
Figure 2: Reinke’s edema can be uneven and irregular making it appear as if there are a number of separate masses. In addition, there is a hemorrhage of one vocal fold in this patient.
What are the symptoms of Reinke’s edema?
Reinke’s edema causes a very characteristic gravelly, low-pitched voice. This is the result of the swelling of the superficial lamina propria which becomes boggy and vibrates less well as it gains in mass. Because the voice is low-pitched, Reinke’s edema is most noticeable in women, but can be overlooked in men, in whom a deep voice is not regarded as odd.
Sometimes, the swelling of Reinke’s edema can become large enough to impair breathing. Initially, this only occurs only during strenuous activity, but may ultimately affect breathing at rest and contribute to sleep apnea, a disorder of breathing during sleep.
Figure 3: Reinke’s edema may occasionally grow so large that it blocks breathing.
What does Reinke’s edema look like?
Vocal folds with Reinke’s edema look swollen along their entire length. The appearance has been likened to water balloons. The swelling of Reinke’s edema can be uneven, and may involve the two vocal folds unevenly. In fact, it may be entirely one-sided as in the first two figures on this page. It is normal for the swelling to shift with breathing, and sometimes, the full extent of the swelling is visible only with a sharp intake of breath.
How is Reinke’s edema treated?
It is essential to recognize that Reinke’s edema is evidence of severe damage from smoking. The initial step in the treatment of Reinke’s edema is to quit smoking.
Early cases of Reinke’s edema may improve with smoking cessation alone. More advanced cases generally do not, but even so, continued smoking makes recurrence likely following treatment, sometimes in a matter of weeks. For that reason, many laryngologists prefer that a patient stop smoking prior to operating on Reinke’s edema.
Figure 4: Microscopic removal of Reinke’s edema can restore vocal fold contour and function. Because the entire vocal fold must be operated, the chance of scar is higher.
If Reinke’s edema fails to improve sufficiently following smoking cessation, microlaryngoscopy surgery is the main treatment option. Surgery for Reinke’s edema has unique difficulties, because the superficial lamina propria must be reduced, but not excessively, in order to preserve vibration of the vocal fold. Too much produces scar and hoarseness that is very difficult to correct. The more surgeries that have to be done, the greater the risk of scarring; hence the importance of stopping smoking before treatment.
Surgery can usually improve the voice substantially and eliminate any breathing difficulty.