Anatomy of the Condition:
The vocal folds are located within the larynx or voice box.  They are structures which open for breathing, and come together during swallowing, and vibrate as air passes between them during speaking or singing.  They are made up of fine layers, with a soft outer cover, a stiffer ligament below this, and a muscle called the thyroarytenoid muscle located deep to the ligament.  The thyroarytenoid muscle makes up the bulk of the vocal fold. Scarring of the vocal folds results in fibrous tissue replacing normal tissue, and reduces the vibration of the vocal folds that allows for a clear voice.

Causes or Contributing Factors
Scarring of the vocal folds can be caused by injury, trauma or systemic diseases.

Symptoms include:

• Hoarseness
• Rough or scratchy voice
• Vocal fatigue and strain
• Increased vocal effort
• Vocal onset delays
• Day to day variablitity in the voice
• Loss of upper range in singing
• Difficulties with vocal register changes in singing

Diagnosis
The voice team will ask the patient about symptoms and their medical history,
followed by a thorough head and neck examination. The examination likely will involve several members of the voice team to assess vocal quality, efficiency, and proper speaking technique.

Laryngeal videostroboscopy may be required.  This is a procedure using a flexible and/or rigid endoscope coupled to a video monitor and a stroboscopic light source to allow for detailed visual evaluation of laryngeal function and vibration.

Microlaryngoscopy may be required.  It is a procedure conducted under general anesthesia which allows the physician to examine the vocal folds of the larynx with magnification tools. 

Treatments
Treatment for vocal fold scarring includes rest and medication to reduce inflammation, and prevention techniques to stop further inflammation.  Surgery may also be required. Surgical treatment options include fat injection laryngoplasty and other procedures to attempt to improve the voice.