Reinke’s Edema

Before and After Treatment for Smoker’s Polyps

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 (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 (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 / 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 (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 (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 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.

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).

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.

Reinke’s (smoking-related) Edema and How to See It

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Convexed vocal cords (1 of 4)

Abducted, breathing position. Note that the margin of both vocal cords is slightly convex. See dotted line for normal, perfectly straight margin.

Inspiratory phonation (2 of 4)

Inspiratory phonation in-draws the mild Reinke’s edema (smoker’s type polyp formation).

Open phase, faint translucency (3 of 4)

Strobe illumination, at E4 (approximately 330 Hz), mostly open phase.

Smoker’s Polyp Reduction Improves Voice Even Though the Larynx Result May not be “Pretty”

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Smokers Polyp (1 of 5)

Six years after vocal polyp removal elsewhere. As a result of continued smoking, the voice is deep and rough, and an obvious recurrent/residual “smoker’s” polyp is seen on the right vocal cord(arrow, left of photo). The patient “hates” her rough and masculine voice quality.

Reine’s edema (2 of 5)

Inspiratory phonation is elicited to “pull” the redundant tissue medially, revealing a lot of Reine’s edema of the left vocal cord, too. The dotted lines show the ellipse of mucosa that will be removed during surgery. Mucose will be preserved at the margins and the gelatinous lateral within the polyps will be suctioned away if liquid, and dissected away if fibrotic.

A week after surgery (3 of 5)

The dotted lines show the extent of mucosal excision—an area that will take a few weeks to re-mucosalize. Since this was a polyp “reduction,” though hoarse this early post, she has a ” functional” voice. There should be no alarm if patients are aphonic for a week or even a few weeks while inflammation resolves.

Residual Reinke’s edema (4 of 5)

At two months post, the patient is very pleased and says the improvement to voice is “large.” Here, it appears there may be some residual Reinke’s edema especially of the left vocal cord (right of photo) judging by the slightly convex margin.

Residual submucosal edema (5 of 5)

With inspiratory phonation, the residual submucosal edema is made obvious, especially on the left. This was (as intended) a polyp “reduction” approach, rather than polyp “removal” as the latter is too hard on voice, and it is not possible to “put back” if too much tissue is taken. Here, there is no stiffness, and if desired, more can be removed. Of course, since the patient is so pleased with her voice, no further treatment is needed.
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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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