“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
What are common complaints of patients with Reinke’s edema?
The voice complaints of patients with Reinke’s edema are similar to those of many other voice disorders. Medical consultation is necessary to identify if a patient’s voice changes are due to Reinke’s edema.
Common Complaints of Patients with Reinke’s Edema
- Persistent hoarseness
- Rough voice
- Low voice
- Voice pitch that is below typical range for age and/or gender
- Loss of voice brilliance
- Loss of luster or edge of voice
- Vocal fatigue
- Voice tires especially after voice use, usually at end of day
- Voice pitch contraction
- Inability to speak in the high vocal range
- Difficulty speaking softly
- Fine-tune control of soft sound is difficult
- Pain or neck tightness
- Discomfort while talking or singing
- Noisy breathing
- Less common
- Shortness of breath
- Feeling that one does not have enough air – especially with exercise
A “Man’s Voice” in Females with Reinke’s Edema
One of the most common complaints in female patients with Reinke’s Edema is that their voice sounds like a man’s voice – especially noticeable when speaking over the telephone. In fact, this complaint is one of the main reasons why more women than men with Reinke’s edema seek medical care.
In rare cases, Reinke’s edema can progress to such a severe level that the enlarged vocal folds cause narrowing of the airway, causing breathing difficulties.
If this scenario does occur, breathing can become noisy (stridor) and can require increased effort, especially during exercise.
Any breathing difficulty needs immediate medical attention.
What are other common observations in patients with Reinke’s edema?
Voice Change Over Years – Not Overnight
Reinke’s edema develops slowly.
“Middle-Age” Group of Patients
Reinke’s edema is usually identified in patients age 40 and 60 years. However, since Reinke’s edema is a gradual, progressive condition, newly diagnosed patients have actually been experiencing the build-up of gelatinous fluid within their vocal folds for many years.
Usually Identified in Women
For unknown reasons, most patients diagnosed with Reinke’s edema are post-menopausal women. However, since many cases of Reinke’s edema are not identitifed, the true incidence of the condition is unknown and could actually be equal for both sexes.
Possible explanation: Low voice in women is more noticeable. The lower-pitched voice common in Reinke’s edema patients is more likely noticed by females – simply because a low voice is unusual in females, unlike a male’s voice. Physicians believe that women report more cases of Reinke’s edema, even if an equal number of men have developed the condition.
Women usually seek surgical intervention: The overwhelming majority of patients who seek surgical intervention for Reinke’s edema are women.
Physicians believe that most individuals (male or female) who smoke over a long period probably develop a certain degree of Reinke’s edema. This condition may be the cause of “smoker’s voice,” the raspy, low-pitched voice, which is often recognizable after years of tobacco use.
Although a review of patient complaints provide important clues towards the identification of Reinke’s edema by the voice physician, examination of the voice box is critical in the identification of Reinke’s edema.
What are the causes of Reinke’s edema?
Vocal Folds Are Highly Sensitive to Irritants
In general, vocal folds are quite sensitive to any irritation. If irritation persists, voice disorders, like Reinke’s edema, will oftentimes result.
Three Main Causes of Reinke’s Edema
Majority of the cases of Reinke’s Edema are caused by one or a combination of the risk factors below.
- Smoking is a major risk factor for Reinke’s edema, just as it is the major risk factor for cancer of the lungs, throat, and voice box. However, not all smokers get Reinke’s Edema.
- Voice overuse and “abuse”: Constant voice overuse, misuse, or “abuse” can cause irritation to the vocal folds – which may result in several voice disorders, one of which is Reinke’s edema.
- Reflux or backflow of stomach fluids to the voice box (laryngopharyngeal reflux): Stomach fluid is highly acidic. Stomach lining cells have special properties to resist irritation from its acidic fluids. The lining cells of the throat and voice box are not resistant however, therefore exposure to stomach fluid backflow (reflux) causes significant irritation to the voice box resulting in various abnormalities and voice disorders, one of which is Reinke’s edema. (For more information, see Reflux Laryngitis.)
Common Risk Factors but Different Voice Disorders
Although these three risk factors can cause Reinke’s edema, not all individuals with these risk factors develop Reinke’s edema.
Physicians are not certain why some people with these risk factors do not develop any voice disorder, or why some develop Reinke’s edema while others develop other vocal fold abnormalities such as vocal fold scarring, vocal fold cancer, or vocal fold cysts.
Factors That Worsen Reinke’s Edema
Although the reasons for why only some individuals get Reinke’s edema are unknown, factors that worsen risk for Reinke’s edema are.
- How long one has been exposed to common risk factors of Reinke’s edema, such as smoking, vocal abuse, and reflux to the voice box: Longer history of smoking increases risk of voice disorders such as Reinke’s edema.
- How severe the risk factor is: Worse reflux increases risk of developing voice disorders such as Reinke’s edema.
- Combination or number of risk factors present: “Double whammy” increases risk of developing voice disorders such as Reinke’s edema.
- Probable genetic, hormonal, and/or behavioral factors: Genetics may explain why Ms. X gets Reinke’s, but Ms. Y, who smokes the same amount, does not.
Some medical conditions: Allergies may affect the risk of developing Reinke’s edema
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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