From the Guidelines
Reinke's edema should not be biopsied unless there are concerning features suggesting malignancy, such as asymmetric lesions, rapid progression, or significant risk factors for laryngeal cancer. The diagnosis of Reinke's edema can typically be made based on clinical appearance during laryngoscopy, which reveals characteristic bilateral, diffuse swelling of the vocal folds with a gelatinous or polypoid appearance, as described in the clinical practice guideline for hoarseness (dysphonia) 1.
Key Considerations
- The management of Reinke's edema primarily involves addressing the underlying causes, particularly smoking cessation, voice therapy, and treatment of laryngopharyngeal reflux.
- Surgical intervention may be necessary to remove the edematous tissue for severe cases affecting breathing or voice quality, but this is typically reserved for cases that don't respond to conservative measures.
- The pathophysiology involves accumulation of fluid in the superficial lamina propria (Reinke's space) of the vocal folds, usually due to chronic irritation from smoking, voice abuse, or reflux disease.
Treatment Approach
- Treatment with proton pump inhibitors like omeprazole 20-40mg daily or pantoprazole 40mg daily for 8-12 weeks may be considered for patients with laryngopharyngeal reflux.
- Voice therapy and smoking cessation are crucial components of the treatment plan.
- Regular follow-up is necessary to monitor the response to treatment and to detect any potential malignant transformation early.
From the Research
Diagnosis and Treatment of Reinke's Oedema
- Reinke's oedema is a benign lesion of the vocal folds, and the risk of malignancy is low, with dysplasia found in 0% to 3% of cases 2, 3.
- The primary risk factor for Reinke's oedema is tobacco use, and other contributory factors include voice overuse and laryngopharyngeal reflux 2.
- Treatment is focused on decreasing risk factors, such as smoking cessation, voice therapy, and reflux control, as well as surgical techniques to decrease redundant polypoid mucosa and improve voice and restore the glottic airway 2, 4.
Biopsy and Malignancy Risk
- Studies have shown that the risk of malignancy in Reinke's oedema is low, with no malignancy reported in a cohort of 189 patients with histologically proven Reinke's oedema 3.
- Another study found no evidence of beginning carcinomas in a group of 48 patients with Reinke's oedema 4.
- Given the low risk of malignancy, biopsy may not be necessary in all cases of Reinke's oedema, especially if the diagnosis is clear based on clinical and morphological characteristics 3, 4.
Classification and Treatment Options
- A proposed classification of Reinke's oedema based on morphological characteristics may help guide treatment decisions 5.
- Treatment options for Reinke's oedema include surgical and nonsurgical approaches, such as cold steel microlaryngeal phonosurgery, microdebrider, CO2 laser, photoangiolytic laser, voice therapy, steroid and hyaluronidase injection 6.
- However, more research is needed to determine the effectiveness of these treatment options, and a comprehensive assessment protocol should be used to evaluate outcomes 6.