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Disorders of the Larynx
by Richard Stasney, MD, Laryngology Advisory Board
Reprinted with permission from The Texas Voice Center

(Most images can be clicked on for a larger view.)

Normal LarynxNormal Larynx - This is an example of a normal larynx. The true vocal folds are pearly white, they meet in the midline on phonation, and the surrounding structures are light pink. As you view the following examples of diseases of the larynx, you can compare them to this example.

Benign Lesions

PrenodulesPrenodules - Prenodules are swelling on the vocal folds in the area where nodules are formed. These are often seen before the vocal folds form calluses known as nodules. Speech therapy can resolve these and prevent their progression.

NodulesNodules - Nodules are calluses on the vocal folds that occur with improper voice use or over use. They are most common in children and females. They prevent the vocal folds from meeting in the midline and thus produce an hourglass deformity on closure resulting in a raspy, breathy voice. Most times these will respond to appropriate speech therapy. Occasionally (20% of the time) these may persist after intensive speech therapy and require meticulous microlaryngeal surgery.
PolypPolyp - Polyps are benign lesions of the larynx, occurring mostly in adult males, that are usually located on the phonating margin (edge) of the vocal folds and prevent the vocal folds from meeting in the midline. Polyps can interfere with voice production and may produce a hoarse, breathy voice that tires easily. These may respond to conservative medical therapy and intensive speech therapy. If the lesion fails to respond, meticulous microsurgery may be indicated. One of the cofactors in the etiology of these lesions may be laryngeal reflux disease.
LaryngoceleLaryngocele - Laryngoceles are dilated areas of the larynx that result from increased pressure over time. They may interfere with phonation or respiration. Some may require surgical treatment.
CystCyst - Cysts are lesions within the vocal folds that often impair their vibration.

Inflammatory Conditions

Laryngitis SiccaLaryngitis Sicca - Laryngitis sicca is caused by inadequate hydration of the vocal folds. Thick, sticky mucus prevents the folds from vibrating in a fluid, uniform manner.

Vocal Cord Concavity

PresbylaryngisPresbylaryngis - Presbylaryngis is a condition that is caused by thinning of the vocal fold muscle and tissues with aging. The vocal folds have less bulk than a normal larynx and therefore do not meet in the midline. As a result, the patient has a hoarse, weak, or breathy voice. This condition can be corrected by injection of fat or other material into both vocal folds to achieve better closure.


PremalignantPremalignant - Leukoplakia is a white growth on the vocal folds. If not treated, it can develop into cancer. Smoking, alcohol use, and reflux are all believed to be factors in the development of this premalignant condition.
CancerCancer - This is an example of a very early cancer of the vocal folds. If these lesions are detected early, they can be treated with either radiation or surgery, with a cure rate approaching 96%.


ParalysisParalysis - Vocal fold paralysis has many causes, and leaves the patient with a very breathy voice, and sometimes with no voice. Thyroplasty is a surgery to correct the gap and restore usable voice. This picture is an example of a patient with vocal fold paralysis before and after thyroplasty. Note the improvement in closure.


HemorrhageVocal fold hemorrhage is a very rare occurrence that usually is caused by aggressive or improper use of vocal folds (e.g. cheerleading). It is a result of rupture of a blood vessel on the true vocal fold, with bleeding into the tissues of the fold.

copyright, 2000 The Texas Voice Center -



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