Additionally, if the edema becomes too severe, patients may experience difficulty breathing due to blockage of the airway. Diagnosis
Reinkes edema is often diagnosed by an Ear, Nose & Throat (ENT) specialist or an Otolaryngologist by examination of the vocal cords. First, the doctor will review the patients medical history and symptoms, such as hoarseness, dysphonia, and reduced vocal range. There is no familial or hereditary link to Reinkes edema. Because Reinkes edema is linked heavily to smoking, the doctor will need to know if the patient is a habitual smoker. Once the patients history is reviewed, the vocal cords will be visualized using laryngoscopy, a technique in which a tube with a camera (endoscope) is passed through the nose and down the larynx. Laryngoscopes can be rigid or flexible. Flexible laryngoscopes, such as fiber laryngoscopes, allow the patient to produce sound as the tube is placed, and therefore allows the doctor to visualize movement of the vocal cord. The use of rigid laryngoscopes generally requires general anaesthesia due to the discomfort involved in distracting the soft tissues of the mouth and pharynx. Based on the results of the laryngoscopy, Reinkes edema can be classified using a standardized system set in place by Yonekawa.
This system characterizes the disease based disease severity.Yonekawa Classification:
Grade I – Lesions contact the anterior third of the vocal fold
Grade II – Lesions contact the anterior two-thirds of the vocal fold
Grade III – Lesions contact the entirety of the vocal foldIf further evaluation is needed, stroboscopy is used to examine mucosal waves of the vocal cords. Mucosal waves describe the waves produced by vibration of the vocal cords during speech. Stroboscopes produce flashes of light that are timed to the patients vocal frequency. Every time the light is flashed, it will create a still frame image of the vocal cords at that particular moment in time. These are combined to produce an image of the wave. In the case of Reinkes edema, structural changes to the vocal cords will result in abnormal wave patterns. Treatment
The first step in treating Reinkes edema is to eliminate or control those risk factors that are causing the disease. This includes the cessation of smoking, the control of gastric reflux using antacids and/or Proton Pump Inhibitors (PPIs), and the discontinuation of activities that cause vocal distress. Those experiencing a hoarseness of the voice may choose to undergo voice therapy to improve the voices quality and range. Most cases of Reinkes edema are caused by the long term usage of cigarettes. In this case, it is important to make lifestyle changes to stop smoking.