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 or 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."
Change in vocal fold = change in vocal fold vibration. The swelling from the gelatinous substance makes the superficial lamina propria or Reinke's space stiff and less flexible, thus reducing vocal fold vibrationhence voice changes and/or problems. (For more information, see Anatomy and Physiology of Voice Production.)
Patients usually have a low, raspy or rough voice. A low voice is particularly striking in women"male quality voice in a female."
Reinke's Edema is caused by vocal fold irritation from voice misuse, smoking, and/or conditions which irritate the vocal folds such as backflow of stomach fluids to the voice box (laryngopharyngeal reflux). It is typically found in middle-aged/post-menopausal women who have a history of smoking cigarettes for many years.
- Reinke's Edema does not go away on its own.
- The cause of Reinke's Edema needs to be identified and treated before treatments directed at the voice disorder (such as voice therapy or surgery) are considered.
Elements of Successful Treatment
Long-term success in the treatment of Reinke's Edema depends upon 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).
Any and all airway problems require immediate attention.
- 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 a microcup forceps. This procedure results in excessive vocal fold scarring.
- If primary causes, such as smoking, reflux, are not addressed, Reinke's Edema will recur.