Furthermore,  cigarette smoke was discovered to increase COX-2 and PGE2 expression in fibroblasts, which could indicate the role of cigarette smoke in Reinkes edema.While smoking is a clear risk factor to Reinkes edema, other risk factors are being identified to explain Reinkes edema in nonsmokers. Research has suggested the role of bacterial colonies in non-neoplastic lesions such as Reinkes edema. Using pyrosequencing, strains of S. pseudopneumoniae were found as the dominant bacterial strain across most non-neoplastic lesions. Of all the sequences analyzed, streptococcus represented 72.9% of bacteria found within these lesions. While smoking, gastric reflux, and vocal abuse have been more widely agreed upon in literature as risk factors for Reinkes edema, the altered bacterial cultures could be developed as a diagnostic tool in the future.The majority of the research within the last ten years focuses on improving surgery for Reinkes edema. Due to the importance of the Reinkes space in speech, it is important that minimally invasive techniques be perfected that minimize the risk of complications. The CO2 laser has been successfully incorporated into the surgical technique, however, there are several other lasers being investigated for use in Reinkes edema. These include photoangiolytic lasers and potassium titanyl phosphate lasers. See also
List of voice disorders
Histology of the Vocal Folds

References
Notes"Benign Vocal Lesions - Nodules, Polyps, Cysts". The Center for Voice at Northwestern University. Archived from the original on August 17, 2007. Retrieved July 24, 2007. External links

"Illustration of Reinkes Edema". The Center for Voice at Northwestern University. Archived from the original on August 17, 2007.
While this will not resolve or improve the edema, the cessation of smoking will halt the diseases progression.If the elimination of risk factors is not sufficient to improve the patients symptoms, surgery may be required. The most common type of surgery performed today for Reinkes edema is called surgical microlaryngoscopy. Most procedures follow the microflap technique set in place by Hirano. During surgery, an incision is made into the vocal cord using either microscissors or a CO2 laser. A flap of mucosa is lifted and the affected tissue is removed using suction or a microdebrider. The flap is then re-draped and trimmed to the appropriate size.Most cases of Reinkes Edema are bilateral - affecting both vocal cords - rather than unilateral. In the case of bilateral edema, the surgeon must choose whether to operate each side of the vocal cord in two separate surgeries or to operate both sides in a single surgery. The complication associated with removing tissue from both sides in a single surgery is that the raw, cut ends of the vocal cords may form an anterior glottis web, in which the two sides grow together in a continuous sheet. Other complications of surgery include tissue scarring due to damage to the vocal ligament during the incision and vocal cord stiffening due to over-suctioning of the superficial lamina propria (Reinkes space).While surgical microlaryngoscopy has its associated risks, if left untreated, Reinkes edema can lead to a variety of long-term complications.