Vocal cord

Synonyms

Vocal ligament, Vocal ligament (Plural)

anatomy

The vocal cords, like other ligaments in the body, are made of elastic connective tissue.

Every healthy person has two vocal cords. These are part of the vocal folds, which are located in the larynx - as vibratory structures of the voice-forming apparatus (glottis) - are located.

The vocal cords lie with the vocal muscle (Vocalis muscle) and are covered by a mucous membrane. These three units - muscles, ligaments, and mucous membrane - together make up the vocal folds.

The vocal folds and thus also the vocal cords are connected to the back with two cartilages (Cartilagines arytaenoideae) and towards the chest with the thyroid cartilage (Cartilago thyroidea) connected and thus stretched.

The gap between the vocal folds is called the glottis (Rima glottidis) and forms the only passage for air between the lungs and the mouth or nose.

When breathing calmly, the glottis is only open between the cartilages. The mucous membranes of the two vocal folds touch each other and are tightly closed. The position of the control cartilage - during increased breathing - creates a wide triangular opening of the glottis (front and rear part open).

Now the vocal folds are open across the entire length and allow the passage of a larger amount of air.

Through the vocal muscle (Vocalis muscle) and the external larynx muscle (Cricothyroid muscle) can we the tension, length and thickness of the vocal folds change, whereby the glottis reaches different opening states. Depending on the setting, this ensures different pitches and volumes our voice (except whispering).

After inhalation, the vocal folds are closed until they pass through the Exhaled air are pressed apart and made to vibrate. The vocal cords open and close as we take air out of the lung press through the glottis (Phonation), up to over 1000 times per second.

At the to cough the glottis opens almost explosively, which among other things causes the barking sound arises.

Disorders of the vocal cord

There is a space between the mucous membrane and the vocal cords (Reinke room), which enables the displacement between the mucous membrane and the ligamentous apparatus. If there is an accumulation of fluid in the Reinke room, it is called Reinke edema (see below swelling of the vocal cords)

A foreign body in the larynx causes an urge to cough so that it can be transported towards the mouth. If this is not possible on your own, you should go to an emergency room as soon as possible. The foreign body should be removed by a doctor under supervision so that bleeding or residues of the foreign body can be excluded and thus possible complications avoided.

The vocal folds become nervous Recurrent laryngeal nerve provided. If this nerve is injured (Recurrent palsy) it can lead to paralysis of the posticus (Crycoarytenoides posterior muscle), which is also incorrectly referred to as "vocal cord paralysis".

The posticus is the only muscle in the larynx that opens the glottis. A one-sided injury to the muscle or nerve means that a vocal fold can no longer be controlled properly. This initially manifests itself as a change in voice or hoarseness.

The very rare bilateral recurrence palsy can lead to breathing difficulties because the glottis can no longer be opened sufficiently to allow air to pass through.

Also are Vocal cord paralysis by violating the Nervi laryngeus superior / inferior possible. This is where the vocal folds can not really tense anymore become. In this case arise no breathing difficultiesbut primarily hoarseness.

At a Intubation (e.g. ventilation in general anesthetic) the ventilation tube is passed past the vocal cords through the glottis. This can lead to a Irritation of the lining of the vocal folds with hoarseness up to an intubation granuloma.

A mostly viral inflammation of the vocal folds (Acute laryngitis) leads to even redness both vocal folds, whereas unilateral reddening is more likely to indicate a specific inflammation, e.g. a carcinoma suggests.

Especially with young children it can be in the context of a acute laryngitis edema in the subglottic space, whereby the vocal folds are only slightly reddened (Subglottic laryngitis, Croup syndrome).

By toxins like nicotine and alcohol it can affect the vocal folds and the lining of the larynx Laryngitis chronica come.

Otherwise, vocal cord polyps can be caused by Overuse of the voice Cause hoarseness. These are to be distinguished Vocal cord nodules (Scream nodules, singer nodules). Each hoarseness the longer than 3-4 weeks persists, should be clarified by an ENT doctor to rule out a malignant change such as vocal cord cancer.

Vocal cord inflammation

Inflammation of the vocal cords can have several causes. A distinction is made between inflammation caused by viruses and inflammation caused by repeated irritation or misuse (incorrect singing or screaming technique).

The symptoms of vocal cord inflammation are diverse. Vocal cord inflammation often leads to hoarseness or an obsession with throat clearing. Speaking can also sometimes cause pain and discomfort. Vocal cord inflammation is usually treated like a cold, for example with inhalations, onion juice, sage and wearing scarves. Antibiotic therapy should only be considered in the case of bacterial infestation. Breathing and voice exercises are useful for prevention. Warming up the voice before singing is also an effective prevention.

Read more on the topic: Inflammation of the vocal cords

Vocal cord irritation

Irritation of the vocal cords can have various causes. As a rule, a distinction is made between acute irritation and chronic irritation. The former can occur, for example, due to an infection or an inhalation trauma (breathing in hot air in a fire). Chronic irritation is more likely to arise on the ground in recurring contact with pollutants such as chemicals or nicotine.

Often, irritation of the vocal cords leads to a feeling of a foreign body as well as to a throat clearing. Hoarseness can also occur. Chronic irritation of the vocal cords can lead to inflammation or vocal cord leukoplakia. The latter is the preliminary stage of cancer. The therapy of choice is to avoid contact with the pollutant or to combat the cause of the irritation.

Vocal cord tear

Vocal cord tears often arise from previous damage to the vocal cords and acute stress. If the vocal cords are stressed intensively and without being warmed up beforehand, small cracks or even complete tears can arise. Intense screams (so-called "screams") or a wrong singing technique are stressful for the vocal cords. To prevent cracks, it is recommended to warm up the voice before singing and to take regular pauses. Learning to sing correctly can also protect against damage. Smoking also damages the structure of the vocal cords. If the vocal cords are torn, pain, hoarseness and voice changes occur. Depending on the degree of injury, a tear in the vocal cords can lead to silence. It is possible to surgically sew the vocal cords back together in order to counteract complete silence.

hoarseness

Hoarseness is a change or disturbance of the voice. Most of the time, the voice sounds rough or thick. A hoarseness is due to a lack of mobility of the vocal cords. This disrupts the vibration of the vocal cords generated by the air and thus also vocal training. Hoarseness can have many causes. Frequent triggers are inflammation and allergies that affect the vocal cords and neoplasms (tumors, cysts, etc.) in the larynx area. Hoarseness can also arise from vocal cord paralysis or after trauma. Various chemicals and smoking can damage the vocal cords over the long term and thus lead to hoarseness.

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Swelling of the vocal cords

A swelling of the vocal cords caused by an accumulation of tissue fluid is also called Reinke's edema. The tissue fluid collects in the space between the vocal folds (Reinke's space). This often arises as part of an incorrect load on the voice. Smoking and exposure to dust can also lead to this. Affected people often complain of hoarseness, coughing and, in severe cases, of shortness of breath. In addition to the physical examination (especially of the lymph nodes), a laryngoscopy can be performed to confirm the diagnosis. A tissue sample can also be taken as part of laryngoscopy. Therapy mainly consists of finding the cause and combating it (abstinence from smoking, saving the voice, etc.). Speech therapy can also correct incorrect strain on the voice. If the swelling is persistent, surgical removal of the affected tissue can be considered.

Read more on the topic: Swollen vocal cords

Vocal cord polyps

Vocal cord polyps are benign tumors of the vocal folds. This benign tumor sits on the vocal folds and can be seen, for example, through a laryngoscopy. Most often it is a spread of the mucous membrane in response to inflammation. Vocal cord polyps can make you feel like a foreign object and, in some cases, can also cause hoarseness. It can also lead to a throat clearing. The treatment of choice is the removal of the polyp as part of a laryngoscopy. After the ablation, a sample should be sent to the pathology department to rule out further differential diagnoses.

Read more on the topic: Vocal fold polyp

Vocal cord leukoplakia

Vocal cord leukoplakia is the name given to the increased cornification of the mucous membrane of the vocal cords. The increase in cornification occurs as a reaction to chronic irritation of the vocal cords, for example from smoking cigarettes or pipes. Excessive consumption of alcohol or recurring inflammation can also promote the development of vocal cord leukoplakia. Most of the time, however, leukoplakia go unnoticed, as these very rarely cause symptoms. However, if the size increases, it can lead to hoarseness or difficulty swallowing. However, vocal cord leukoplakia can potentially degenerate and thus lead to vocal cord cancer. For this reason, they should be removed and the cause (e.g. smoking) should be combated.

Vocal cord cancer

Cancer or carcinoma of the vocal cords mostly affects the elderly and is a special form of larynx cancer. Carcinomas of the vocal cords often arise from chronic irritation of the vocal cords from toxic substances such as nicotine, cement dust, asbestos or sulfuric acid vapor. Chronic acid reflux or radiation exposure are also risk factors for vocal cord cancer. Those affected often complain of hoarseness, shortness of breath or a dry cough.

Find out more about the topic: vocal cord cancer - what you should know about it

With the help of a laryngoscopy it is possible to view the vocal cords and to take samples of suspicious parts. It is important to have a sample examined by the pathology department, because the therapy depends heavily on the type and size of the tumor. In the early stages, removal of the vocal cords or radiation therapy can be helpful; in advanced tumors, the entire larynx must often be removed. Because of the early symptoms and the low rate of spread, the prognosis for vocal cord cancer is good.

Examination of the vocal cord

If the examining doctor looks into the mouth without equipment, he can only look to the back of the tongue and assess the upper throat. In order to get a better insight into the lower lying smoking room and the larynx, the doctor must have a larynx mirror (Laryngoscope) use. This larynx mirror usually has a light source so that something can be seen at all. In addition, you can get a flash light (Stroboscope) make use of. This makes it possible to better assess the vocal fold vibrations during sound formation and possible paralysis is easier to detect.

The examination can trigger a gag reflex in the patient, which is why the doctor should be informed of this by the patient if the gag reflex is severe.