What are the causes of vocal cord edema (swelling)?

From the Guidelines

Vocal cord edema is primarily caused by acid exposure, voice overuse, irritants, allergies, infections, reflux disease, and trauma, with acid exposure being a significant mechanism as it can cause inflammation in the upper airway, leading to edema and inflammatory responses 1. The causes of vocal cord edema can be multifactorial, including:

• Voice overuse from excessive talking, singing, or shouting, which strains the vocal cords, causing inflammation and swelling
• Environmental irritants like smoke, chemicals, and pollutants that directly damage vocal cord tissue
• Allergic reactions to pollen, dust, or foods that trigger inflammatory responses in the larynx
• Infections such as laryngitis, typically viral or bacterial in nature, leading to inflammation and fluid accumulation
• Gastroesophageal reflux disease (GERD) that causes stomach acid to irritate the vocal cords, resulting in chronic inflammation, as supported by the study on the impact of concomitant medications on obstructive sleep apnea 1
• Physical trauma from intubation, as seen in patients who are intubated more than 36 hours, which can lead to laryngeal edema and postextubation stridor 1 Other contributing factors include hormonal changes, certain medications like inhaled steroids, autoimmune conditions, and systemic diseases that affect fluid balance. Treatment depends on the underlying cause but may include voice rest, hydration, humidification, anti-inflammatory medications, antibiotics for bacterial infections, proton pump inhibitors for reflux, and in severe cases, corticosteroids or surgery.

From the Research

Causes of Vocal Cord Edema

The causes of vocal cord edema can be attributed to various factors, including:

• Viral illnesses, which can cause direct inflammation of the vocal cords or irritation due to postnasal drainage 2
• Bacterial infections, such as acute epiglottitis, which can also cause dysphonia but typically have other systemic symptoms as well as respiratory distress 2
• Prolonged external irritation to the vocal cords, which may cause an edematous state of the vocal cords known as Reinke's edema 3
• Smoking, which plays a major role in the etiology of Reinke's edema 4
• Vocal trauma, which can lead to the formation of vocal fold cysts 4
• Chronic overuse or stress on the vocal cords, resulting in nodules or polyps, particularly in individuals in certain occupations such as singers, school teachers, and chemical workers 2
• Gastroesophageal reflux disease, postnasal drip, upper or lower respiratory tract infection, and irritants, which can trigger vocal cord dysfunction 5

Risk Factors

Certain individuals are at greater risk of developing vocal cord edema, including:

• Those in occupations that involve heavy voice use, such as singers, school teachers, and chemical workers 2
• Smokers, who are more likely to develop Reinke's edema 4
• Individuals with a history of vocal trauma, which can lead to the formation of vocal fold cysts 4

Associated Conditions

Vocal cord edema can be associated with various conditions, including:

• Dysphonia, which can be caused by abnormal laryngeal muscle spasms (vocal cord closure is less severe) 5
• Dyspnea, which can be caused by Reinke's edema or vocal cord paralysis 3
• Laryngitis, which can be caused by viral or bacterial infections 2