What happens to the vocal folds
Under the mucous membrane of the vocal fold there is a loose layer that ensures its wave-like vibrations. Constant irritation from tobacco smoke disrupts microcirculation and the functioning of lymphatic vessels; viscous liquid accumulates in this layer. The folds thicken, sag, and take on the appearance of gelatinous ridges. Due to the increased mass, they vibrate more slowly and the fundamental frequency of the voice decreases - this is why the voice becomes lower. With severe edema, thickened folds begin to narrow the lumen of the larynx.
- Fluid accumulation in Reinke's space
- Thickening and sagging of folds
- Slowing down vibrations and lowering the pitch of the voice
- Bilateral lesion
- Stages from mild edema to polypous ridges
- Narrowing of the lumen of the larynx with a pronounced form
Causes and risk factors
The leading factor is smoking, and both experience and the number of cigarettes are important; The disease practically does not occur in non-smokers. A significant contribution is made by constant vocal stress, especially loud speech against the background of smoking. The reflux of acidic gastric contents into the pharynx maintains chronic irritation of the mucous membrane. Less likely to contribute to the development of edema is reduced thyroid function, work in conditions of dust and chemical fumes, as well as prolonged exposure to dry air.
- Smoking is a major factor
- Voice stress and loud speech
- Gastroesophageal reflux
- Reduced thyroid function
- Occupational hazards and dust
- Dry air and dehydration
Symptoms
The voice changes gradually, over months and years, so a person often gets used to it and does not consider it a problem. The timbre decreases, rudeness and hoarseness appear, women are often mistaken for men over the phone. The voice quickly gets tired, the ability to speak quietly and sing is lost. They may be bothered by the sensation of a foreign body in the throat, the need to cough, coughing in the morning. With significant swelling, shortness of breath on exertion and noisy breathing appear, especially during sleep.
- Low rough voice
- Hoarseness and loss of voice
- Rapid voice fatigue
- Inability to speak quietly and sing
- Feeling of a lump in the throat
- Morning cough
- Shortness of breath and noisy breathing with severe edema
Diagnostics
The doctor examines the larynx using an endoscope: the characteristic picture of gelatinous, thickened folds usually makes it possible to make a diagnosis immediately. Video stroboscopy shows a slow and excessive mucosal wave. It is important to evaluate the symmetry of the process: Reinke's edema is always bilateral, so a unilateral formation requires special attention and, as a rule, a biopsy to exclude a tumor. Additionally, the doctor checks the smoking history, voice stress, the presence of reflux and, if necessary, prescribes a test of thyroid function.
- Endoscopic examination of the larynx
- Video stroboscopy of vocal folds
- Assessment of lesion symmetry
- Biopsy for unilateral or atypical process
- Testing for gastroesophageal reflux
- Thyroid function assessment
- Analysis of voice loads and working conditions
Treatment and prevention
The first and mandatory step is a complete cessation of smoking: without it, any treatment gives only a temporary result, and after surgery the swelling returns. For mild changes, quitting tobacco, vocal hygiene and treating reflux is sometimes enough to achieve a noticeable improvement. In case of persistent edema, a microsurgical operation is performed: excess gelatinous contents are removed through the larynx, preserving the mucous membrane as much as possible, often in stages on each side. After the intervention, vocal rest and sessions with a phonopedist are necessary.
- Complete smoking cessation
- Vocal hygiene and load dosing
- Treatment of gastroesophageal reflux
- Adequate drinking and air humidification
- Microsurgical removal of edematous tissue
- Step-by-step intervention on each fold
- Voice rest and rehabilitation with a phonopedist
