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.)

Key Glossary Terms Reinke's Edema "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 "Stripping" 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 Glossary

Key Information

• 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.)

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.)

Key Information

A Note on "Chronic Laryngitis"

"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.

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.

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.)

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.

Red Flag

• 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.

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.

Red Flag

Any and all airway problems require immediate attention.

Symptoms

Treatment

Advisory Note