Key Information. Anecdotally, voice physicians have observed that many vocal fold injuries occur when singers sing while their vocal folds are swollen during an infection, such as an upper respiratory infection or a cold. Inflammation of the vocal folds due to exposure to stomach fluids can delay the normal healing process, resulting in vocal fold scarring.
The presence of reflux laryngitis is also suspected to aggravate vocal fold scarring from phonotrauma. Systemic diseases e. Vocal fold scarring may be congenital birth defect. In this situation, a child is born with a severely hoarse voice from congenital scarring or vocal fold abnormality. Vocal fold scarring can occur in children as well as adults and in men as well as women. The exact incidence is unknown, partly due to a difficulty in diagnosis. In addition, many patients may have a vocal fold scar that is not clinically significant.
A minor degree of scarring might not affect the average individual to the point where evaluation and medical care are sought; the same degree of scarring might, however, be completely disabling to a professional singer. The symptoms associated with vocal fold scarring are similar to those of other voice disorders. Therefore, medical evaluation is imperative when symptoms of a voice disorder occur.
Advisory Note Patient education material presented here does not substitute for medical consultation or examination, nor is this material intended to provide advice on the medical treatment appropriate to any specific circumstances. All use of this site indicates acceptance of our Terms of Service. Overview Understanding the Disorder Symptoms Diagnosis Treatment Frontiers Key Glossary Terms Vocal Fold Scar Abnormal scar tissue in the vibrating layer of the vocal fold that causes voice problems Lamina Propria Vibrating component of the vocal folds that covers the vocal fold muscle or body; the lamina propria is composed of three layers: superficial, intermediate, and deep lamina propria Mucosal Wave Wave-like motion of the vibrating layer of the vocal fold as seen upon slow motion-like viewing through stroboscopy Stroboscopy Laryngoscopy with synchronized strobe light that provides a slow motion-like view of vocal fold vibration mucosal wave ; stroboscopy is the key tool used to analyze vocal fold vibration Glossary What is vocal fold scarring?
Vocal Fold Scar Spectrum Scarring can range from mild to severe, and can occur in one spot or along the full length of the vocal fold. Voice use over time aging Voice misuse poor singing technique, forceful speaking Voice abuse loud screaming Injury can be worse in the presence of other vocal fold problems, such as reflux laryngitis. Scar tissue can also result from the repair process following surgery on the vocal folds.
Any changes in any of these components, in any combination, results in decreased pliability, thus altering vocal fold vibration. Vocal fold vibration is the key element of sound production during speaking and singing.
Altered vocal fold vibration — depending on severity and extent — can cause a range of symptoms such as hoarseness, breathy voice, increased effort to speak, and voice fatigue.
But the demands of these roles can take their toll, and people may find themselves dealing with vocal strain or fatigue, struggling to keep pace. The key is understanding how we damage our voices and how to better protect them. Three types of behaviors can put a someone at risk for vocal damage: vocal abuse, misuse, and overuse. Because of overlap between the terms, some experts use vocal misuse and vocal abuse interchangeably.
Vocal abuse refers to behaviors that strain or injure the vocal folds, also called vocal cords. Vocal folds are the bands of muscle that vibrate to create sound inside the larynx, which is the hollow organ managing airflow and sound at the top of the windpipe.
Abusive behaviors include smoking and vaping, not drinking enough water, screaming and yelling, coughing, and frequent throat clearing.
Vocal misuse means improper use of the voice. An example is speaking at a higher or lower pitch than is natural, which can happen when an individual repeatedly uses their voice in a different register or adapts a different tone to meet the demands and needs of their environment. Another example of potential misuse is vocal fry also called glottal fry , which is when a person speaks in a low, creaky tone.
Vocal fry causes vibrations in the ventricular folds, rather than the true vocal folds. Chronic use of vocal fry could lead to laryngeal tension and vocal fatigue, according to Parker. Vocal overuse is using the voice frequently without having enough rest. Overuse can happen when someone regularly extends their voice beyond normal capacity. Potentially risky scenarios include a podcast host recording several episodes in a row to accommodate a holiday break or a fitness instructor capitalizing on their growing popularity by livestreaming three more classes a day.
Vocal abuse, misuse, and overuse all can lead to strain and fatigue. If these behaviors do not change, individuals may experience serious vocal damage or even a voice disorder.
Other causes of vocal damage include certain allergy and sinus infection medications, acid reflux, dry environments, and neurological disorders such as vocal paresis, a nerve injury. With small changes in routine and environment, individuals can make a significant difference in their vocal health and longevity.
Speech Baylor offers advice from therapists and vocal practitioners below. Caring for the body supports a healthy voice. Warming up before using your voice and cooling down afterward can help reduce strain. Try the following quick vocal warm-up exercises and vocal cool-down exercises:. Lauren Polovoy, a therapeutic specialist in articulation and language disorders, suggests making small adjustments to protect your voice.
Ask yourself:. She typically recommends clients drink between 0. Reduce consumption of caffeine, soda, and alcohol, which can dry the vocal folds. If you drink coffee, balance it with water to avoid dehydration. Parker encourages clients to think of their voices as a finite savings account: People can draw funds when needed but must spend wisely. Careful management practices include:. A personal amplifier is a microphone that people can wear to safely project their voices without having to yell or speak from the back of the throat.
Instead, use full breaths and release the air slowly while speaking to increase volume. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Thanks for visiting. Don't miss your FREE gift. Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health , plus the latest advances in preventative medicine, diet and exercise , pain relief, blood pressure and cholesterol management, and more.
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