due to a greater change in vocal pitch and quality. surgery is capable of restoring the voice, with the condition that smoking is not resumed after surgery. reinke's edema is not a life-limiting pathology unless the tissue becomes precancerous. research recent studies have examined the role of specific cell types in reinke's edema, including the role of vocal cord fibroblasts. in normal tissue, these spindle-shaped cd34+ fibroblasts produce extracellular matrix proteins such as collagen and elastin. recent findings have shown a morphological change in fibroblasts extracted from the tissue of reinke's edema to a more dendritic-like shape with several protrusions. large populations of these altered cd34+ fibroblasts have been found surrounding the areas of edema. they lack normal expression of several cluster of differentiation (cd) proteins and express additional proteins that are not expressed in normal vocal cord fibroblasts. cigarette smoke was discovered to increase cox-2 and prostaglandin e2 (pge2) expression in fibroblasts, which could explain the role of cigarette smoke in reinke's edema. while smoking is a clear risk factor for reinke's edema, others are being investigated to explain reinke's edema in nonsmokers. research has suggested the role of bacterial colonies in non-neoplastic lesions such as reinke's edema. in one study using pyrosequencing, thirty-one of the forty-four non-neoplastic lesions sampled were found to have streptococcus pseudopneumoniae bacterial strains as the dominant bacteria present. species of streptococcus were present in every lesion analyzed, representing 72.9% of all bacteria found specifically within reinke's edema lesions and 68.7% of bacteria across all the vocal fold lesions sequenced. while smoking, gastric reflux, and vocal abuse have been more widely agreed upon in literature as risk factors for reinke's 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 reinke's edema. due to the importance of the reinke's space in speech, it is important that minimally-invasive techniques be perfected that minimize the risk of complications. the carbon dioxide laser has been successfully incorporated into the surgical technique; there are several other lasers being investigated for use in reinke's edema. these include photoangiolytic lasers and potassium titanyl phosphate lasers.