Voice disorders can result from the swelling of the non-muscle part of the vocal fold that is right underneath its surface lining (i.e., in the superficial lamina propria, also known as Reinke's space). This condition is called Reinke's edema, which literally means "swelling in Reinke's space" or "build-up of fluid in Reinke's space."

A change in a vocal fold causes change in vocal fold vibration. The vocal fold swelling makes the superficial lamina propria (Reinke's space) stiff, thus reducing vocal fold vibration – hence voice changes and/or problems. (For more information, see Anatomy & Physiology of Voice Production.)

Patients usually have a low, raspy, or rough voice. A low voice is particularly striking in women – a male-quality voice in a female.

Reinke's edema is caused by vocal fold irritation from voice misuse, smoking, and/or conditions that irritate the vocal folds, such as backflow of stomach fluids to the voice box (laryngopharyngeal reflux). Reinke's edema typically occurs in middle-aged/post-menopausal women who have a long-term history of smoking cigarettes.

Long-term success in the treatment of Reinke's edema requires two, sometimes three approaches.

Although Reinke's edema usually develops slowly over the course of many years, the condition can worsen to the point of causing problems with breathing (airway problems).

Red Flag

Any and all airway problems require immediate attention.

Red Flag

• According to current best practices, there is no role for "vocal cord/vocal fold stripping" in treating Reinke's edema. "Vocal cord/vocal fold stripping" refers to the removal of vocal fold epithelium using microcup forceps. This procedure results in excessive vocal fold scarring.
• If primary causes, such as smoking or reflux, are not addressed, Reinke's edema will recur.

Advisory Note