“Swelling in Reinke’s space”; a voice disorder caused by accumulation of gelatinous substance in Reinke’s space
Reinke’s Space (Superficial Lamina Propria)
Layer just underneath the surface lining of the vocal fold; composed of cells, special fibers, and other substances (extracellular matrix); has key role in vocal fold vibration
A “radical” surgical procedure that removes (“strips”) the top layers of the vocal folds resulting in severe vocal fold scarring and abnormal voice. Due to the resultant damage, this procedure is at present rarely used
How is Reinke’s edema treated?
The first question that patients with Reinke’s edema must answer is: “Do I want treatment?” Since Reinke’s edema is a benign condition – and since its treatment often involves difficult lifestyle changes, some individuals simply choose to live with its effects.
In fact, surgery is mainly indicated when patients are sufficiently motivated to eliminate the cause or causes, such as quitting smoking. Surgery is also indicated in patients who may be at a high risk for vocal fold cancer.
First-Line Treatment: Elimination of Cause or Causes
To improve the voice-related symptoms associated with Reinke’s edema, therapy focuses on treating or controlling the condition’s three primary causes.
- Reflux or backflow of stomach fluids to the voice box (laryngopharyngeal reflux, or LPR)
- Voice overuse or abuse
Elimination of these causes is absolutely essential to successful treatment of Reinke’s edema. The recommended means of eliminating these causes are briefly described below.
Smoking: Stopping, or severely cutting back, the smoking of cigarettes (and to a lesser extent pipes and cigars). A smoking cessation program is often helpful, especially if you have tried to quit smoking but have failed.
Reflux or backflow of stomach fluids to voice box: Lifestyle changes minimize backflow of stomach fluids, as do medications (such as proton pump inhibitors) to reduce acid production in the stomach. (For more information, see Reflux Laryngitis.)
Voice overuse/abuse: Vocal prioritization leads to voice preservation – that is, minimizing both in frequency and duration, episodes of voice strain.
Often, by removing the irritation that causes Reinke’s edema, these basic treatments can improve the voice disorder – although not completely, as explained below.
Second-Line Treatment: Restoring Voice Function
Unfortunately, treating the underlying causes of Reinke’s edema will usually not completely restore a voice to its normal quality. Second-line treatment plays a role in improving voice function for patients to meet social and professional demands on voice. There are two approaches two second-line treatment.
- Surgical treatment to improve voice function (phonomicrosurgery)
- Voice therapy
Phonomicrosurgery: Key Second-Line Treatment
If hoarseness and other voice complaints persist after treating the underlying causes of Reinke’s edema, surgical removal of Reinke’s edema material within the vocal folds may be necessary. Surgery to improve voice in patients with Reinke’s edema is performed using microsurgical techniques ( phonomicrosurgery). Phonomicrosurgery is done by a qualified voice specialist surgeon or laryngologist. (For more information, see Phonomicrosurgery.)
Care After Surgery – Voice Rest
After surgery, physicians typically ask patients to completely rest their voices (no voice use) for a short period of time (several days to two weeks). Voice rest allows the area of surgery to heal optimally, and to minimize recurrence of Reinke’s edema.
Sometimes, however, even after vocal rest is completed, voice may remain breathy, weak, and maybe even high-pitched for a short period of time (four to six weeks) after surgery. Typically, these symptoms will subside after the vocal folds have fully healed from surgery and may disappear even sooner with voice therapy.
Scarring from phonomicrosurgery: Although the small, precise instruments used in phonomicrosurgery are designed to minimize the risk of scarring, it is a risk with surgical incision. Additionally, incomplete voice rest immediately following surgery can prevent proper healing of vocal folds, which can lead to scarring
Voice fatigue or strain: After surgery for Reinke’s edema, patients may experience voice fatigue or strain. These complications are rare and usually result from postsurgical scarring or poor speaking technique from failing to adhere to voice therapy.
Voice Therapy: A Key Component of Treatment of Reinke’s Edema
Following voice rest after surgery, voice therapy is often recommended to assist in adjusting to the new shape, movement, and function of the surgically corrected vocal folds. Briefly, voice therapy helps rehabilitate voice, as well as re-train patients to speak with correct form and without harming the vocal folds. (For more information, see Voice Therapy.)
For Reinke’s edema patients, voice therapy is most likely to be prescribed for three reasons.
- Reason 1: If the underlying cause of Reinke’s Edema was voice misuse or abuse – voice therapy can help ensure that this abuse does not continue.
- Reason 2: If surgery for Reinke’s edema has significantly altered the shape of the vocal folds (more likely in patients who had developed significant amounts of Reinke’s material build-up), producing sound may seem awkward at first. Fortunately, voice therapy can help re-train these individuals how to speak.
- Reason 3: If patients with Reinke’s edema have developed “bad voice habits” to compensate for the voice disorder, voice therapy can help patients re-learn proper technique.
Surgical Treatment Alone Is Not Enough
When surgical treatment is done for Reinke’s edema without first treating the underlying cause(s) of the disorder – LPR, smoking, or vocal abuse – patients often experience a recurrence of Reinke’s edema or persistence of their voice problem despite the success of the surgical procedure itself.
Current Best Practices: No Role for “Vocal Cord / Vocal Fold Stripping”
Surgical treatment for Reinke’s edema should use precise phonomicrosurgical technique.
“Vocal cord / vocal fold stripping” refers to the removal of the top cell layer of the vocal fold (vocal fold epithelium) using microcup forceps. This stripping of the vocal fold epithelium results in severe vocal fold scarring and abnormal voice with very little promise for recovery.
Vocal cord / vocal fold stripping has been shown to result in scarring in the deeper layers of the vocal folds in the superficial lamina propria and even down to the vocalis muscle. The procedure can also result in the formation of scar tissue between the vocal folds or webbing which, if severe, can decrease the size of the airway passage thus causing shortness of breath.
According to current best practices, there is no role for vocal cord / vocal fold stripping in treating Reinke’s edema.
Steroid Therapy Is Not a Medical Treatment for Reinke’s Edema
Steroid medication is not a treatment for the swelling in Reinke’s edema.
Steroid Therapy Considered Only for Emergency Airway Problems
If breathing is impaired in patients with Reinke’s edema, steroid therapy may be prescribed to improve airway access while other treatment methods (reflux treatment, voice therapy, and/or surgery) are given.
Patient education material presented here does not substitute for medical consultation or examination, nor is this material intended to provide advice on the medical treatment appropriate to any specific circumstances.
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