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Otolaryngologist Plays Key Role in Identification of Reinke’s Edema
Reinke’s edema is typically diagnosed by a surgeon-specialist of ear, nose, and throat diseases (ENT or otolaryngologist) or in some cases, an otolaryngologist who specializes in voice (laryngologist).
Examination Findings That Lead to Identification of Reinke’s Edema
As with all human diseases, identification of the type of voice disorder depends on putting together clues from patient information, findings from medical examination, special exams, and laboratory tests (when performed). (For more information, see Overview of Diagnosis, Treatment & Prevention.)
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
Question Addressed: Is Reinke’s edema present?
Examination Technique: Viewing voice box through rigid or flexible laryngoscopy (For more information, see Laryngoscopy/Stroboscopy.)
Examination Findings: Enlargement of one or both vocal fold that move, albeit hampered by the increase in size
Question Addressed How do the vocal folds function?
Examination Technique: Evaluation of effects of Reinke’s Edema on vocal fold vibration by videostroboscopy (For more information, see Laryngoscopy/Stroboscopy.)
- Confirmation of enlarged vocal folds
- Other abnormalities caused by voice overuse: e.g., vocal fold scarring, nodules, cysts, etc.
- Other changes caused by reflux of stomach fluids to voice box (e.g., redness, thickening of lining cover, increased mucous production)
Question Addressed: Are there any other abnormalities?
Examination Technique: Examination for other abnormalities that may also result from the cause or combination of causes of Reinke’s edema during laryngoscopy and videostroboscopy (For more information, see Laryngoscopy/Stroboscopy.)
- Rule-out of cancer or pre-cancer lesions
- Increased amplitude of “mucosal wave” of vocal fold vibration
- Movement of vocal folds “within normal limits” but easily fatigued
If smoking is the primary cause of Reinke’s edema, rule-out of cancer in the voice box, head/neck region, and/or lungs is a priority.
In general, other than videostroboscopy, no other special testing such as x-rays or laryngeal electromyography (LEMG) is required to obtain an accurate diagnosis of Reinke’s edema.
In patients with one-sided Reinke’s edema, vocal fold weakness from nerve damage needs to be investigated. In these cases, physician voice specialists will often prescribe a laryngeal electromyography examination. (For more information, see LEMG.)
Voice Disorders That May Be Mistaken for Reinke’s Edema
When Reinke’s edema is misdiagnosed, it is often mislabeled as “chronic laryngitis” (see note box) or vocal fold polyp. (For more information, see Vocal Fold Nodules, Polyps, Cysts, and Reactive Lesions.)
- “Chronic laryngitis” is a non-specific term referring to the inflammation of the voice box (laryngitis) that lasts a long time (chronic).
- “Chronic laryngitis” is not a specific voice disorder, but rather an abnormal finding whose cause needs to be identified to properly treat the voice disorder.
Several other conditions can sometimes be confused with Reinke’s edema due to similar symptoms and/or similar appearances.
- Vocal fold edema
- Polypoid corditis
- Smoker’s laryngitis
Smoking as a Risk Factor for Both Reinke’s Edema and Voice Box Cancer
Not Present Together: Reinke’s Edema and Cancer of the Vocal Fold
Individuals with voice-related problems visit a physician mainly because they are concerned about whether they have laryngeal cancer, since laryngeal cancer is life threatening, although rare. Fortunately, despite smoking as a major risk factor to both conditions, Reinke’s edema and laryngeal cancer are rarely seen at the same time in individuals. The reason for this is not presently known.
Present Together: Reinke’s Edema and Pre-cancer of the Vocal Fold – Vocal Fold Atypia
Although laryngeal cancer and Reinke’s edema are not usually seen together, pre-cancerous lesions on the vocal fold (vocal fold atypia) are more frequently observed with Reinke’s edema. Since these growths can turn into cancer over time, careful voice box examination needs to be done. (For more information, see Vocal Fold Atypia and Early Cancer.)
Other Confounders to Identification of Reinke’s Edema
Reinke’s edema can also be confused with voice disorder caused by low levels of thyroid hormone (hypothyroidism). Though this condition rarely affects the vocal folds, the voice-related complaints are similar to those of Reinke’s edema.
Careful medical investigation needs to be done if hypothyroidism is suspected, especially if other patient complaints or findings are suggestive of low thyroid hormone levels, such as fatigue, weight gain, and hair thinning/loss.
If Reinke’s Edema has progressed to the point where it affects breathing (noisy breathing, or stridor), the disorder may be mislabeled as asthma. Again, careful medical examination is necessary. Alternatively, both may be present.
Noisy breathing (stridor) is a sign of obstruction or narrowing of the laryngeal or tracheal parts of the airway.
Stridor is a sign of difficulty passing air.
Any breathing difficulty needs immediate medical attention.
Key Role of Voice Box Examination
Accurate identification of voice disorders depends on careful voice box examination of both vocal fold appearance and function. Voice box examination needs to be done. A physician voice specialist is often the best person to perform this examination.
Any and all airway problems require immediate attention.
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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