Symptoms of Vocal Fold Scarring

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

Hoarseness is the most common symptom associated with vocal fold scarring. Hoarseness causes the voice to decrease in pitch and to become rough and raspy.

Vocal fold scarring causes poor or reduced vocal fold vibration. To vibrate and produce sound the scarred, stiffened vocal folds demand greater effort from the entire voice production mechanism (lungs and muscles of the throat). Patients often complain that they have to work harder to produce voice. Talking softer or louder, or over background noise may be more difficult. (For more information, see Anatomy & Physiology of Voice Production.)

Vocal fold scarring limits ability to change the pitch, nature, and volume of the voice during speech and/or singing due to the stiffened vocal fold. Patients complain of an inability to control pitch, decreased pitch range and frequent pitch breaks during voice use. This is referred to as voice instability during pitch transitions, such as when a singer changes the song pitch from his or her chest voice to his or her head voice.

Because producing voice may take more energy, the voice tires more easily. A patient may feel too tired to talk unless it is absolutely necessary.

Since vocal fold scarring develops gradually, patients will typically notice voice changes over time. The singer or speaker will notice difficulty "warming up" the voice or a slow decline in voice quality, such as:

• Change in roughness
• Change in pitch
• Gradual increase in effort used to speak
• More frequent voice fatigue

When vocal fold scarring occurs after either intubation or external trauma to the larynx, patients complain of hoarseness that does not completely resolve with time and/or rest.

Often, a common cold lifts but hoarseness does not. If hoarseness persists for two weeks or longer after the common cold lifts, a voice disorder, such as vocal fold scarring, is likely.