Polypoid Degeneration

Diffuse swelling of the vocal cords, due to build-up of edema fluid within the mucosa. Polypoid degeneration is also referred to as Reinke’s edema or smoker’s polyps. This condition is most often seen in long-term smokers who are also somewhat talkative. In other words, polypoid degeneration is rare in talkative non-smokers and also rare in taciturn smokers.

Symptoms of polypoid degeneration

Polypoid degeneration tends to virilize (masculinize) the quality and capabilities of the voice, and this effect is most noticeable in women. Also, in more severe cases, polypoid degeneration can induce involuntary inspiratory phonation or a fluttering, almost snoring sound during sudden inhalation.

Appearance of polypoid degeneration

Polypoid degeneration typically appears as pale, watery bags of fluid attached to the superior surface and margins of the vocal cords. In less severe cases, the swelling might be more subtle, but if the patient is instructed to inhale while making voice, then the polypoid tissue will be drawn away from the cords into the glottic aperture, giving each vocal cord margin a convex contour and thereby becoming more noticeable (see two such examples in the photos below).

Treatment for polypoid degeneration

The patient is encouraged to give up smoking. Short-term voice therapy can help in some cases, reducing the turgidity of the polypoid tissue and thereby improving the voice to a small but noticeable extent. However, the polypoid degeneration itself is permanent, so if the voice quality remains unacceptable to the patient even after voice therapy, then surgery is necessary.

For surgery on polypoid degeneration, it was once common to strip away the polypoid tissue, but this approach often leads to an unacceptably high-pitched, thin-sounding, and husky voice. A better method is to reduce the tissue more conservatively, potentially leaving some fractional residual polypoid tissue. This way, although the voice might remain mildly virilized, it also retains a richer and more effortless quality.

Smoker’s Polyps, before and after Surgery (audio with photos)

Voice sample of a patient with smoker’s polyps, BEFORE surgery (see this patient’s photos just below):

Same patient, two months AFTER surgery (the occasional syllable dropouts are due to the recentness of surgery):

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Smoker’s polyps, BEFORE surgery (1 of 4)

Even during quiet breathing, the convexity of the vocal cord margins (dotted lines show where normal margins would be) reveal the presence of smoker’s polyps.
Smoker's polyps, BEFORE surgery

Smoker’s polyps, BEFORE surgery (1 of 4)

Even during quiet breathing, the convexity of the vocal cord margins (dotted lines show where normal margins would be) reveal the presence of smoker’s polyps.

Smoker’s polyps, BEFORE surgery (2 of 4)

During inspiratory phonation: the polyps are drawn inward and are easier to see.
Smoker's polyps, BEFORE surgery

Smoker’s polyps, BEFORE surgery (2 of 4)

During inspiratory phonation: the polyps are drawn inward and are easier to see.

Smoker’s polyps, AFTER surgery (3 of 4)

Two months after surgery, during quiet breathing. The vocal cord margins are now straight.
Smoker's polyps, AFTER surgery

Smoker’s polyps, AFTER surgery (3 of 4)

Two months after surgery, during quiet breathing. The vocal cord margins are now straight.

Smoker’s polyps, AFTER surgery (4 of 4)

During inspiratory phonation: the margins are drawn into a mildly convex contour, but far less than preoperatively. The patient’s voice is also much improved, albeit the occasional syllable dropouts due to recentness of surgery (listen to this patient’s voice samples in the audio section of the encyclopedia entry).
Smoker's polyps, AFTER surgery

Smoker’s polyps, AFTER surgery (4 of 4)

During inspiratory phonation: the margins are drawn into a mildly convex contour, but far less than preoperatively. The patient’s voice is also much improved, albeit the occasional syllable dropouts due to recentness of surgery (listen to this patient’s voice samples in the audio section of the encyclopedia entry).

 

Polypoid Vocal Nodules

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Polypoid vocal nodules (1 of 4)

Polypoid vocal nodules in a “vocal overdoer” with phenomenology typical for a mucosal injury. Narrow band illumination (blue-green light) makes vasculature more prominent. Note also the fusiform (long, low-profile) swelling, best seen on the left cord (right of image).
Polypoid vocal nodules

Polypoid vocal nodules (1 of 4)

Polypoid vocal nodules in a “vocal overdoer” with phenomenology typical for a mucosal injury. Narrow band illumination (blue-green light) makes vasculature more prominent. Note also the fusiform (long, low-profile) swelling, best seen on the left cord (right of image).

Incomplete closure (2 of 4)

Phonation, strobe light, at the beginning of the closed phase of vibration; one can see that closure will be incomplete due to early contact of the polypoid nodules.
Polypoid vocal nodules

Incomplete closure (2 of 4)

Phonation, strobe light, at the beginning of the closed phase of vibration; one can see that closure will be incomplete due to early contact of the polypoid nodules.

Polypoid vocal nodules (3 of 4)

Phonation, strobe light, closed phase of vibration, with persistent gaps anterior and posterior to the polypoid nodules.
Polypoid vocal nodules

Polypoid vocal nodules (3 of 4)

Phonation, strobe light, closed phase of vibration, with persistent gaps anterior and posterior to the polypoid nodules.

Polypoid vocal nodules (4 of 4)

Phonation, strobe light, open phase of vibration, continues to show the mid-cord swellings.
Polypoid vocal nodules

Polypoid vocal nodules (4 of 4)

Phonation, strobe light, open phase of vibration, continues to show the mid-cord swellings.

Smoker’s Polyps / Reinke’s Edema

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Smoker’s polyp / Reinke’s edema (1 of 2)

Quiet breathing, under standard light. The edematous mucosa is not yet evident.
Smoker’s polyp / Reinke’s edema

Smoker’s polyp / Reinke’s edema (1 of 2)

Quiet breathing, under standard light. The edematous mucosa is not yet evident.

Smoker’s polyp / Reinke’s edema (2 of 2)

Elicited inspiratory phonation in-draws and thereby reveals the edematous mucosa, greater on the right (left of image) than the left. The dashed lines indicate the normal location and contour of the vocal cords’ free margins.
Smoker’s polyp / Reinke’s edema

Smoker’s polyp / Reinke’s edema (2 of 2)

Elicited inspiratory phonation in-draws and thereby reveals the edematous mucosa, greater on the right (left of image) than the left. The dashed lines indicate the normal location and contour of the vocal cords’ free margins.

Example 2

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Smoker’s polyps / Reinke’s edema (1 of 3)

This patient is a long-term smoker, and also is talkative. Her voice has been gradually deepening for years. Here, with the vocal cords in abducted breathing position, one can only see somewhat underwhelming, broad-based, low-profile swelling, along with some hazy leukoplakia in the mid-cord.
Smoker’s polyps / Reinke’s edema

Smoker’s polyps / Reinke’s edema (1 of 3)

This patient is a long-term smoker, and also is talkative. Her voice has been gradually deepening for years. Here, with the vocal cords in abducted breathing position, one can only see somewhat underwhelming, broad-based, low-profile swelling, along with some hazy leukoplakia in the mid-cord.

Smoker’s polyps / Reinke’s edema (2 of 3)

Phonation. Again, there is only very low-profile, broad-based convexity of the margins, and again, the hazy leukoplakia in the mid-cords.
Smoker’s polyps / Reinke’s edema

Smoker’s polyps / Reinke’s edema (2 of 3)

Phonation. Again, there is only very low-profile, broad-based convexity of the margins, and again, the hazy leukoplakia in the mid-cords.

Smoker’s polyps / Reinke’s edema (3 of 3)

Elicited inspiratory phonation. Now, one can see that, contrary to the appearance in the prior two views, this patient in fact has moderate-sized “smoker’s-type” polyps, aka Reinke’s edema. The increased mass explains the virilization of the sound of this woman’s voice.
Smoker’s polyps / Reinke’s edema

Smoker’s polyps / Reinke’s edema (3 of 3)

Elicited inspiratory phonation. Now, one can see that, contrary to the appearance in the prior two views, this patient in fact has moderate-sized “smoker’s-type” polyps, aka Reinke’s edema. The increased mass explains the virilization of the sound of this woman’s voice.

Smoker’s Polyps in Various “Poses”

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Smoker’s polyps in various “poses” (1 of 4)

Vocal cord abduction for breathing, during expiratory phase. Left polyp (right of photo) appears to be the only finding. This is in a middle aged smoker with several years of gradually deepening / masculinized and now rough voice. The black dot and white “X” are reference points, facilitating comparisons with the other photos.
Smoker’s polyps in various “poses”

Smoker’s polyps in various “poses” (1 of 4)

Vocal cord abduction for breathing, during expiratory phase. Left polyp (right of photo) appears to be the only finding. This is in a middle aged smoker with several years of gradually deepening / masculinized and now rough voice. The black dot and white “X” are reference points, facilitating comparisons with the other photos.

Polyp begins to fall off (2 of 4)

At the beginning of elicited rapid inspiration, showing the polyp beginning to be displaced from upper surface to the margin. That is, previously-unseen polypoid tissue (at ” X”) is now indrawing from upper surface of the right cord (left of photo) as well, and margin has become convex rather than straight as it was in photo 1.
Smoker’s polyps in various “poses”

Polyp begins to fall off (2 of 4)

At the beginning of elicited rapid inspiration, showing the polyp beginning to be displaced from upper surface to the margin. That is, previously-unseen polypoid tissue (at ” X”) is now indrawing from upper surface of the right cord (left of photo) as well, and margin has become convex rather than straight as it was in photo 1.

Polyps displace (3 of 4)

The left-sided polyp (right of photo) is now displaced below the margin of that cord. The right polyp (left of photo) is now fully displaced/ indrawn to the margin of the right cord (left of photo).
Smoker’s polyps in various “poses”

Polyps displace (3 of 4)

The left-sided polyp (right of photo) is now displaced below the margin of that cord. The right polyp (left of photo) is now fully displaced/ indrawn to the margin of the right cord (left of photo).

Edematous tissue causes a rough voice (4 of 4)

During voice-making, most of the edematous tissue relocates back to the upper surface of the cords where it vibrates chaotically to add not only masculine but also rough voice quality.
Edematous tissue causes a rough voice

Edematous tissue causes a rough voice (4 of 4)

During voice-making, most of the edematous tissue relocates back to the upper surface of the cords where it vibrates chaotically to add not only masculine but also rough voice quality.
Play Video
Smoker’s Polyps (aka Polypoid Degeneration or Reinke’s Edema)
This video illustrates how smoker’s polyps can be seen more easily when the patient makes voice while breathing in (called inspiratory phonation). During inspiratory phonation, the polyps are drawn inward and become easier to identify.

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