Reinke's Edema

What is Reinke’s edema?

Reinke’s edema (polypoid corditis, vocal cord edema) is swelling of your vocal cords (vocal folds). This voice disorder happens when fluid builds up in the outer layer of your vocal folds. It’s most common in people with a long-term history of smoking. But it can also occur in people with chronic acid reflux or a history of repetitive vocal trauma.

Vocal cord edema is a benign condition, meaning it doesn’t indicate cancerous or precancerous cells. Rather, it’s a sign of vocal cord damage. The swelling (which can occur on one or both sides of your voice box) causes hoarseness, and it can make your voice noticeably deeper. In severe cases, it can block your airways and cause breathing issues.

Reinke’s edema usually isn’t serious, and it doesn’t always require treatment. But it’s important to know that your voice probably won’t improve without quitting tobacco or having surgery. If you have unwanted vocal changes, reach out to an otolaryngologist. They’re here to help.

How common is Reinke’s edema?

Reinke’s edema is rare, affecting less than 1% of the general population. It’s most common in people over 50 who smoke.

According to research, people assigned female at birth (AFAB) are more likely to have Reinke’s edema compared to people assigned male at birth (AMAB). But this is probably because people AFAB are more likely to notice symptoms like voice deepening. People with naturally deeper voices may not notice these changes — and as a result, might not seek treatment.

What are the symptoms of Reinke’s edema?

Reinke’s edema symptoms may include:

• Changes in vocal quality or loudness.
• Gradual deepening of your voice.
• Hoarseness or raspiness.

Many people with Reinke’s edema feel that using their voice requires more effort than usual. Your voice might feel especially tired or strained.

Less common symptoms include:

• Difficulty speaking softly.
• Discomfort when talking or singing.
• Inability to speak or sing in your higher vocal range.
• Neck pain or tightness.
• Shortness of breath (dyspnea).
• Noisy breathing (stridor).

What causes Reinke’s edema?

Long-term smoking is the number one cause of vocal cord edema.

Other causes include:

• GERD/acid reflux.
• Laryngopharyngeal reflux (LPR).
• Prolonged exposure to irritants, like chemicals.
• Vocal overuse or trauma (speaking, singing or anything in excess that strains your vocal cords).

How is Reinke’s edema diagnosed?

A otolaryngologist will do a physical examination of your head and neck, including laryngoscopy, to directly visualize your vocal cords. Specifically, they’ll check your:

• Airways.
• Mouth.
• Throat.
• Thyroid.

During your visit, your provider will gather more information about your symptoms and medical history. They may ask questions like:

• When did you first notice changes to your voice?
• What other symptoms do you have?
• How do your symptoms affect your daily life?
• What past or current health conditions do you have?
• Do you smoke? If so, how much?
• Do you drink alcohol? If so, how much?
• Have you ever received an acid reflux diagnosis?
• What medications do you take?
• Have you ever had surgery?
• Have you ever had radiation therapy?

What tests will be done to diagnose Reinke’s edema?

Your provider will use laryngoscopy to look directly at your vocal folds. If you have Reinke’s edema, you’ll have areas of swelling and/or polyp-like growths that resemble tiny grapes or water balloons.

They’ll also do a voice analysis to evaluate various features of your voice like pitch, quality and airflow. During this analysis, they’ll examine your voice box and ask you to speak into a microphone while they record you.

Reinke’s edema grading

There are several classification systems that grade the severity of Reinke’s edema. One 2020 research study proposed a new system that combines previous systems into a single type:

How is Reinke’s edema treated?

The main goal of Reinke’s edema treatment is to restore or improve vocal function. Treatment depends on what caused the swelling. Providers usually start with nonsurgical treatments like quitting smoking. If you try a nonsurgical approach and still have vocal cord swelling, your provider will talk with you about surgical options.

Nonsurgical Reinke’s edema treatment

To get rid of Reinke’s edema, you must treat the underlying cause. To do this, your healthcare provider might recommend:

• Quitting smoking. If you smoke, stopping is the first step. In mild cases, this can even reverse vocal fold edema.
• Medications for GERD and LPR. If you have acid reflux, your provider may prescribe medications like H2 blockers or proton pump inhibitors. Or they might recommend nutritional changes to reduce reflux.
• Voice therapy. A speech-language pathologist (SLP) can use voice therapy to strengthen vocal function and help heal your vocal folds. Providers use voice therapy in combination with nonsurgical and surgical treatments.

Surgical Reinke’s edema treatment

If nonsurgical treatments don’t resolve your symptoms, your provider will discuss next steps, which may include:

• Microlaryngoscopy. A surgeon views your vocal cords with a microscope and uses tiny instruments to remove swollen tissue.
• Laser therapy. A surgeon uses light energy to remove or reduce the size of growths on your vocal folds.

Following surgery, it’s important to avoid the things that caused Reinke’s edema in the first place. Continued smoking or untreated acid reflux can cause swelling to come back, even after surgery — sometimes, in a matter of weeks.

How long does it take to recover from Reinke’s edema treatment?

After surgery for Reinke’s edema, recovery takes about four to six weeks. Your provider may also recommend complete vocal rest for five to seven days. This gives your vocal folds plenty of time to heal before using them again.

Can Reinke’s edema be prevented?

You can prevent most cases of Reinke’s edema by avoiding known risk factors. If you smoke, quitting will drastically reduce your risk for vocal cord edema. If you have symptoms of acid reflux, talk to your healthcare provider about medications that can help. If you use your voice frequently, take steps to avoid overuse.

What’s the outlook for Reinke’s edema?

People with Reinke’s edema generally have a good outlook. While vocal cord edema causes unwanted symptoms, it’s usually not harmful. And if you avoid risk factors, chances are the condition won’t come back.

When should I see my healthcare provider?

Sometimes, Reinke’s edema can narrow your airways and cause breathing issues. Tell your healthcare provider right away if you notice these symptoms. If your voice changes and it lasts for four weeks, you should seek care from an otolaryngologist to directly visualize your vocal cords.

A note from Cleveland Clinic

Vocal cord edema doesn’t usually have an impact on your health. But it can cause noticeable changes in your voice, which can be a source of frustration or embarrassment. Surgery can help. But to keep your symptoms from coming back, you’ll need to avoid risk factors like smoking or overusing your voice. Ask your healthcare provider about treatment options.