Polypoid degeneration

Diffuse swelling of the vocal cords, due to build-up of edema fluid within the mucosa. Polypoid degeneration is also referred to as Reinke’s edema or smoker’s polyps. This condition is most often seen in long-term smokers who are also somewhat talkative. In other words, polypoid degeneration is rare in talkative non-smokers and also rare in taciturn smokers.

Symptoms of polypoid degeneration:

Polypoid degeneration tends to virilize (masculinize) the quality and capabilities of the voice, and this effect is most noticeable in women. Also, in more severe cases, polypoid degeneration can induce involuntary inspiratory phonation or a fluttering, almost snoring sound during sudden inhalation.

Appearance of polypoid degeneration:

Polypoid degeneration typically appears as pale, watery bags of fluid attached to the superior surface and margins of the vocal cords. In less severe cases, the swelling might be more subtle, but if the patient is instructed to inhale while making voice, then the polypoid tissue will be drawn away from the cords into the glottic aperture, giving each vocal cord margin a convex contour and thereby becoming more noticeable (see two such examples in the photos below).

Treatment for polypoid degeneration:

The patient is encouraged to give up smoking. Short-term voice therapy can help in some cases, reducing the turgidity of the polypoid tissue and thereby improving the voice to a small but noticeable extent. However, the polypoid degeneration itself is permanent, so if the voice quality remains unacceptable to the patient even after voice therapy, then surgery is necessary.

For surgery on polypoid degeneration, it was once common to strip away the polypoid tissue, but this approach often leads to an unacceptably high-pitched, thin-sounding, and husky voice. A better method is to reduce the tissue more conservatively, potentially leaving some fractional residual polypoid tissue. This way, although the voice might remain mildly virilized, it also retains a richer and more effortless quality.

Audio with photos:

Voice sample of a patient with smoker’s polyps, BEFORE surgery (see this patient’s photos just below):

Same patient, two months AFTER surgery (the occasional syllable dropouts are due to the recentness of surgery):



Smoker’s Polyps (aka Polypoid Degeneration or Reinke’s Edema)
This video illustrates how smoker’s polyps can be seen more easily when the patient makes voice while breathing in (called inspiratory phonation). During inspiratory phonation, the polyps are drawn inward and become easier to identify.