Vocal Fold Scarring: Highlights

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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

Vocal fold scarring is abnormal scar tissue in the vibrating layer of the vocal fold. Vocal fold scarring causes a number of voice disorders that are problematic to patients and is very challenging to diagnose and treat.

• Scar as a response to injury: A vocal fold scar is "disorganized tissue" in the vibrating layer of the vocal fold that forms as a response to injury or stress (as would occur in the rest of the body).
• Altered viscoelasticity decreases ability to vibrate: The scar tissue alters the pliability (viscoelasticity) of the vocal fold, thus decreasing its ability to vibrate during speaking or singing.
• Scar spectrum: The scar tissue can range from mild to severe and can occur in one spot or along the full length of the vocal fold, resulting in varying degrees of loss of ability to vibrate.

• Injury can result from "wear-and-tear" stress on the vocal folds during:
  • Demanding voice use (by preachers, singers, teachers, etc.)
  • 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.

• Vocal fold scar tissue is "stiffer" than the surrounding area, thus resulting in altered vocal fold vibration.
• Any alteration in vocal fold vibration or ability to vibrate causes voice symptoms such as hoarseness, breathy voice, voice effort, voice fatigue – symptoms that are common to other voice disorders as well.

Diagnosing vocal fold scar is difficult. Examination by stroboscopy (which involves a synchronized strobe light and offers a magnified view of the larynx) is necessary to detect the altered mucosal wave typically seen in vocal fold scar.

Voice therapy and/or singing voice therapy can provide satisfactory voice improvement with better technique, as well as help prevent continued scar formation.

Surgery for vocal fold scarring can successfully treat certain components of the associated voice problems. However, surgery usually does not completely resolve all voice limitations due to vocal fold scar. Determination of the best treatment strategy for vocal fold scarring remains a key focus of research in the field.

Although there is still no definitive intervention for vocal fold scarring, substantive improvement and (more importantly) prevention of continued scarring can be attained though multidisciplinary voice care and intervention. However, a complete return to normal function – especially for singing – cannot be expected.