Recallab › Question bank › ENT › #50595
Reinke's oedema
A 48-year-old woman who smokes heavily has a progressively deeper voice over months. Laryngoscopy shows diffuse, symmetrical, pale gelatinous swelling of both vocal cords along their whole length, with normal mobility. What is the diagnosis, and what layer is affected?
- A. Laryngeal carcinoma; the full thickness of the cord
- B. Laryngeal papillomatosis; the epithelium diffusely
- correctC. Reinke's oedema; fluid in the superficial lamina propria of the vocal cord
- D. Vocal nodules; the epithelium at the junction of the anterior and middle thirds
Explanation
Key fact
Diffuse, symmetrical and gelatinous points to oedema, not to a tumour. The fluid collects in one specific potential space.
Reinke's oedema, with fluid in the superficial lamina propria. That layer is Reinke's space.
Why
Reinke's space is the loose superficial lamina propria beneath the epithelium.
It has few lymphatics, so fluid accumulates readily and drains slowly.
Chronic smoking and voice abuse are the drivers.
The added mass lowers the frequency of vibration, so the voice deepens.
It is bilateral, symmetrical and does not restrict cord movement.
Reinke's space and where the fluid sits
Why not the others
- A. Laryngeal carcinoma; the full thickness of the cord — would be asymmetrical and irregular, often with impaired mobility, and demands biopsy.
- B. Laryngeal papillomatosis; the epithelium diffusely — produces exophytic wart-like lesions and is caused by human papillomavirus.
- D. Vocal nodules; the epithelium at the junction of the anterior and middle thirds — are discrete symmetrical bumps at that point, not diffuse swelling along the whole cord.
Remember
Deep voice, diffuse gelatinous cords, heavy smoker.
Go deeper
A deepening voice in a woman is the presentation that brings her to clinic, and is worth asking about specifically.
Stopping smoking is essential; without it, surgery recurs.
Microlaryngeal surgery removes the fluid and redundant mucosa, and is staged one cord at a time to avoid an anterior web.
Dhingra PL, Dhingra S. Diseases of Ear, Nose and Throat, 9th ed. (Elsevier, 2025).