Health A-Z

Medical Content Created by the Faculty of the
Harvard Medical School

Vocal-Cord Disorders

What Is It?

Vocal cords are two bands of elastic muscle tissue located side by side in the voice box (larynx) just above the windpipe (trachea). When you are silent, the cords remain open, creating an airway through which you breathe. When you speak, the air you exhale from your lungs is forced through the closed vocal cords, causing them to vibrate faster for higher-pitched sounds, slower for lower-pitched sounds.

Like other tissues in the body, vocal cords can be strained and damaged. But unlike a strained arm or leg muscle, strained vocal cords generally aren't noticed until the problem becomes severe. People who use their voices for a living or who shout or scream frequently are at particular risk. This group includes lawyers, teachers, singers, cheerleaders, actors and clergy. People who work in noisy environments, such as airports or racetracks, that require shouting to communicate are also at risk.

Vocal cords are also subject to infections, tumors and trauma.

Common vocal cord disorders include:

• Vocal cord nodules are small, hard, callus-like growths caused by vocal abuse. They occur in pairs, with one nodule on each vocal cord at the site of greatest irritation. They sometimes are called singer's, screamer's or teacher's nodules.

• Vocal cord polyps are small, soft growths that usually appear alone on a vocal cord. They are caused most often by vocal abuse or long-term exposure to irritants, such as chemical fumes or cigarette smoke.

• Contact ulcers, a less common disorder, are erosions and sores on the vocal cords of people who consistently use great force when beginning to speak, instead of gradually increasing force and loudness. Contact ulcers may affect people who work as public speakers, physical education teachers and people who work in noisy environments. Ulcers also can be caused by gastroesophageal reflux (GERD) or heartburn, occurring when highly acidic stomach contents flow back up the esophagus and irritate the larynx.

• Laryngitis is swelling of the vocal cords caused by inflammation or infection. Swollen vocal cords vibrate differently than usual, changing the typical sound of your voice. You can lose your voice if the inflammation is so severe that you can't make a sound. Laryngitis can be caused by vocal abuse, allergies, viral infection, reflux of stomach acids or exposure to irritating substances, such as cigarette smoke or too much alcohol.

• Vocal cord tumors, which can be cancerous (malignant) or not cancerous (benign), occur most often in men aged 60 or older. Benign tumors can be caused by a virus or may be unusual growths of body tissue that will cause voice problems. Cancerous tumors are most likely to occur in smokers and people who drink too much alcohol. Cancerous tumors are life threatening if not caught and treated early. Rarely, tuberculosis bacteria can form a vocal cord lump that looks similar to cancer.

• Vocal cord paresis occurs when one or both vocal cords don't open and close properly, changing voice quality. When one or both vocal cords don't move at all, this is called vocal cord paralysis. If both vocal cords are paralyzed and remain in the closed position, breathing can be difficult. Vocal cord paresis and paralysis can have several causes, including:

  • Surgical trauma, most often from thyroid surgery, but also from any neck or chest surgery

  • Head or neck trauma

  • Trauma during birth

  • A neurological disease (such as Parkinson's disease or multiple sclerosis)

  • Stroke

  • A tumor

  • A viral infection

  • Some debilitating diseases, such as myasthenia gravis

Paresis also can be the result of weakened vocal cord muscles. Vocal cord muscles can be weakened temporarily as a side effect of inhaled corticosteroid medicine sprays, or because of extended treatment with an artificial respirator (ventilator) in an intensive care unit.