Treatment of Reinke's Edema
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.
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.
 Key Information
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.
 Red Flag
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.
Key Information
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.
Red Flag
Any and all airway problems require immediate attention.
|
