Information for patients with problems affecting the muscles the vocal folds. This is commonly termed vocal fold bowing.


  • Underuse
    • Insufficient voice use or insufficient vocal vigor can play a role. These are people who might be termed vocal underdoers. For example, an individual might have an unusually taciturn personality, live alone, and/or work at a job that requires very little talking.
  • Aging
    • The general physical changes that accompany aging may cause a loss of strength, elasticity, and bulk to the vocal folds.
  • Paralysis
    • Thyroid or chest surgery may leave a person with a paralyzed vocal fold. This may also occur spontaneously, after a cold, or from unknown causes.
  • Loss
    • Partial loss of a vocal fold. Surgery, such as to remove a tumor, may leave one vocal fold smaller.
  • Scarring
    • Injuries and scarring to the voice box may occur after a breathing tube has been necessary for a prolonged period. Surgery on the vocal fold may also leave scarring that stiffens the vocal fold.
  • Congenital
    • One may be born with or genetically determined to have or develop relatively thin vocal folds. Just like there are all types of bodies, there are all sizes of vocal cords.


  • Trouble speaking in noisy environments
    • This includes trouble being heard by others as well as unusually rapid fatigue or wearing out of the voice when used in a noisy area. Some people may even complain of light-headedness after speaking in a noisy environment.
  • A whispery quality to the voice
    • There is a lot of air escaping.
  • A coarse quality to the voice
    • One is speaking using the false vocal folds.
  • Reduced vocal endurance
    • The voice fades or becomes foggy. It may sound hoarse after use.
  • Breathing more often
    • When speaking, fewer words than normal may be produced on each breath and more breaths are required than before to complete a sentence.

Appearance of the vocal folds

  • The vocal folds may be bowed, thinned and/or convex, rather than straight.
  • There is a noticeable gap in the center that results in air loss during speaking.
  • One or both vocal folds may have decreased mobility.
  • Primarily, or only, the false vocal folds are being used to phonate.
  • The vocal folds may not be able to touch or reach each other.
  • The vocal folds may move but fail to vibrate from stiffness and/or scarring.
  • The vocal folds may have an irregular edge or even scar bands connecting the vocal folds.

Voice-building program

To benefit the most, adopt the following program under the supervision of a speech pathologist (voice therapist).

  • Schedule two or three practice sessions per day, on your own, each lasting about 10 minutes. Use your voice in a robust fashion during each session.
  • Do not yell or scream, rather, use your "voice of authority" or "opera singer voice." 
  • Pretend you are speaking to an audience in a large room without a microphone... "Four score and seven years ago...".   You may read the newspaper or a book out loud for something to say. Many people have exercised their voice on their daily commute in the car. To passers by, they appear to be talking on a car phone. Content is not important, robustness is. Some have just described the surroundings out loud. "I see a two story, red brick house! There goes a green minivan!..."
  • Visit the entire range of the voice, both high and low. Robust hooted "oooo" sounds can be very helpful. Vocalizations may be produced when breathing in as well. This has been particularly helpful with scarring.

Results of voice building

  • Strength
    • Vigorous usage over several weeks can increase the strength and bulk of the vocal muscles. Both of these changes can lead to improved closure of the vocal folds with a stronger voice. There will also be a more efficient use of the air passing between the vocal folds. This can also lead to increased endurance.
  • Flexibility
    • Loosening up scarred, stiffened vocal folds can start vibration again, even after severe scarring or a prolonged loss of voice.


A high percentage of people with the above problems will see an improvement in their voice and it's capabilities. It is impossible to know if you will benefit until you have followed this treatment on a disciplined basis for at least three weeks. You should have a follow up examination after this time to evaluate your progress.

If you do notice a benefit, you should continue on this regime until there is no further improvement. Like athletes in training, most people will not be at their maximum improvement in three weeks. When a maximum improvement has been attained, the benefit to the voice can usually be maintained with regular, but perhaps less extensive voice use.


If you are dissatisfied with the results of voice building, there usually are other options, including injections or surgical options that may benefit your voice.