Reinke’s edema was discovered in 1895 by anatomist Friedrich Reinke. The benign swelling on the vocal folds leads to impaired speech. If Reinke’s edema is not chronic, it can be made to subside by simple measures such as voice-sparing and abstaining from smoking and alcohol.
What is Reinke edema?
Reinke’s edema is a tissue swelling of the vocal folds that leads to impairment of the vocal cords. Tissue water leaking from the capillary vessels collects under their mucosa. Reinke’s edema can be unilateral or bilateral. The thickening of the vocal cords results in restricted movement of the vocal folds in the air stream. This leads to a hoarse voice (dysphonia). In extreme cases, it fails (aphonia) or slips in the pitch of the voice. Reinke’s edema usually affects women between the ages of 40 and 60. It can occur as acute edema, for example, when the voice is briefly overloaded. In such a case, the watery, transparent swelling usually subsides a few hours later. Inflamed edemas are no longer transparent, but reddened. If they are chronic and are not surgically removed, nodules may form on the vocal folds, leading to voice loss.
Causes
Exactly how Reinke’s edema develops is still unclear. However, risk factors include heavy smoking over many years and excessive alcohol consumption. In addition, excessive or incorrect vocal strain (singers, teachers) is causative. People who are exposed to particulate matter, chemical vapors, and other respiratory irritants for prolonged periods for occupational reasons also have an increased risk of developing Reinke’s edema. Recent clinical studies show that there may even be a hormonal link between the storage of hyaluronic acid in the vocal fold epithelium and the development of Reinke’s edema. If the wrong breathing technique is used, the vocal cords are also put under additional strain. The influence of gastric acid rising into the mouth and throat (reflux) has not yet been clarified. Too dry room air also has an aggravating effect.
Symptoms, complaints and signs
The swelling of the vocal folds causes a slightly raspy to extremely hoarse voice, depending on the extent of the swelling. It is also sometimes deeper than usual. Prolonged speech is considered too strenuous by the affected person and is therefore often refrained from. If the edema is more severe, the patient may even lose his or her voice, or the voice may change pitch, as in the case of a pubertal voice change. If the glottis becomes even more constricted, breathing problems (shortness of breath) are the result. Reflux, increased mucus production, frequent coughing up, pressure and a lump in the throat occur. Since voice flow is impeded by the narrowing of the glottis, patients with Reinke’s edema have additional articulation difficulties. Sometimes the condition also appears as a symptom in the setting of chronic nonspecific laryngitis.
Diagnosis and course of the disease
In Reinke’s edema, the cervical lymph nodes and larynx are palpated to rule out strep throat. Then, a detailed examination of the mouth, throat, and vocal cords is performed using laryngoscopy. A tissue sample (biopsy) is taken to rule out other causes, such as granuloma, infiltration, or malignant tumors.
Complications
Reinke’s edema can lead to hoarseness or even loss of voice, depending on the extent of the swelling. Further narrowing of the glottis results in breathing problems such as shortness of breath and dyspnea. There may also be increased mucus production, whooping cough and the familiar lump in the throat. Narrowing of the glottis often results in articulation difficulties. If the condition occurs as a symptom of chronic non-specific laryngitis, severe inflammation and acute respiratory distress may be added. Persistent voice disorders cannot be ruled out either, depending on the extent of the inflammation. If bacteria are the cause of laryngitis, the inflammation sometimes spreads further. Abscesses and phlegmon form in the larynx. In conjunction with Reinke’s edema, severe pain and further complications often develop. Treatment of Reinke’s edema via stripping results in visible scars. Typically, there is bruising, induration, and occasionally infection and wound healing problems. In addition to these surgical risks, lymphatic or nerve injuries can also occur during stripping.If nerves are injured, this may result in sensory disturbances. The globule Arum triphyllum C5 prescribed concomitantly with the procedure can cause mucosal inflammation if the dosage is incorrect.
When should one go to the doctor?
Reinke’s edema should always be treated by a doctor. Only early diagnosis and treatment can prevent further symptoms, so that the life expectancy of the affected person is also not limited. A doctor should be consulted for Reinke’s edema if the patient permanently has a very hoarse or rough voice and can therefore only speak deeply. In severe cases, there may also be a complete loss of voice, and some sufferers experience a change in voice. Shortness of breath may also be an indication. Likewise, persistent heartburn may indicate Reinke’s edema and should be examined by a physician if the symptoms persist for a long time and do not disappear on their own. In the first instance, Reinke’s edema can be examined and treated by an ENT physician. In severe cases, however, preventive examinations regarding cancer are also useful in order to detect and treat it at an early stage. As a rule, the life expectancy of the affected person is not negatively affected by Reinke’s edema and there is a positive course of the disease.
Treatment and therapy
Severe chronic Reinke edema, in which breathing is also restricted, must be surgically removed. This is done with the help of stripping: the phonosurgeon removes the tissue swelling after local or general anesthesia using tiny forceps or laser technology. Local anesthesia only is more suitable because the patient is still awake during the operation and his voice can then be better assessed: The vibration behavior of the vocal fold mucosa can then be monitored stroboscopically. Whether the operation has brought the desired success can be seen at the earliest two to three months after the operation, because only then is the wound healing process completely finished. If both vocal folds are affected by the edema, the patient’s voice will not return to normal until the second has also been operated on. However, both vocal folds can only be operated on with the same anesthesia if the swellings are insignificant: They could otherwise fuse together during the healing process. If the operation is performed under general anesthesia, the patient must stay in the clinic for three to six days. After the surgical procedure, he should immediately undergo speech therapy to improve his speech, breathing technique and posture. Acute cases of Reinke’s edema are treated by the ENT physician with a cortisone-containing spray. In addition, the affected person should definitely quit smoking and also limit his alcohol intake. The same applies to the period after the surgical intervention. If the patient starts smoking or drinking alcohol again, the vocal folds will swell again. As a general rule, the affected person should definitely take care of his or her voice – regardless of whether he or she has only acute or minor chronic edema or has just undergone surgery. Minor swellings can even be treated homeopathically. The patient takes 5 globules of Arum triphyllum C5 orally every hour. If the symptoms subside, the intake takes place at longer intervals and is discontinued when the symptoms have subsided. The patient should follow the dosage exactly, otherwise inflammation of the mucous membrane may occur.
Prevention
Prevention could be for people who have to speak and sing a lot in their jobs to drink plenty of fluids, use their voice more often only in warm rooms, and always suck Emser salt pastilles in between. In addition, they should not smoke and consume little alcohol.
This is what you can do yourself
Reinke’s edema usually needs to be surgically removed. The vocal folds are subsequently irritated and should not be irritated by speaking or eating irritating foods. The patient should work out a suitable diet with a nutritionist and the doctor in charge. The diet plan must be followed consistently to avoid irritation of the vocal cords. Accompanying this, the triggers for the condition must be eliminated. If the consumption of alcohol or cigarettes is causative, abstaining from these substances applies. Small swellings can sometimes be treated homeopathically.The patient is best to contact an alternative medical practitioner so that a suitable therapy can be initiated. Effective is for example the globule Arum triphyllum C5, which can also be taken independently in consultation with the family doctor. When the symptoms subside, the dose prescribed by the doctor can be gradually reduced. It is essential for the patient to adhere to the dosage. Otherwise, mucosal inflammation may occur, which is associated with significant health complaints. Reinke’s edema is not a serious disease, but it requires permanent monitoring by a specialist. After completion of the initial treatment, regular follow-up is indicated. It is best for the patient to contact a specialist and inform him or her of any symptoms and complaints.
Follow-up
The extent to which follow-up care becomes necessary depends on whether the typical symptoms of Reinke’s edema can be completely resolved. If this is successful, no further treatment is necessary given the absence of symptoms. In all other cases, permanent treatment is necessary. In view of the threat of voice loss, medical support is particularly important in speech professions. This teaches affected individuals how to adopt a wide range of behaviors and exercises to prevent or reduce recurrence. They must perform these on their own responsibility. Avoiding particulate matter and stopping smoking are essential. Patients also participate in speech therapy sessions that help them avoid misuse of the vocal cords. The length of scheduled follow-up visits and their intensity depends on the severity of the symptoms. The question of unilateral and bilateral localization of the complaints also plays a role. In principle, the check-up also serves to discuss a surgical intervention. However, this is usually the last conceivable measure. Physicians usually trust logopedic therapies. In most cases, they lead to the desired treatment success. During an examination, the pharynx is inspected extensively. The main focus is on the vocal cords, which are examined via laryngoscopy.