Vocal Problems Overview

Voices Are Essential

We all rely on our voices to communicate, but teachers, sales people and performers count on their voices as their livelihood. Think of what can happen when the voice doesn’t work the way it should.

Otolaryngologists, sometimes known as ENT (ear, nose and throat) physicians, specialize in the care and treatment of the highly specialized tissues and organs in this part of the body. One of the several subspecialties - focused areas of medical practice - is laryngology, which concentrates on the organs and function of the larynx, and how sounds are produced. Otolaryngologists specializing in laryngology diagnose and treat voice problems, particularly in performers.

The larynx

Larynx. Vocal cords.

The anatomical voice box, or larynx, is composed of delicate tissues which are required to do a lot of work, especially in people who use their voices a lot. The vocal cords are specialized ligaments that open and close to protect the airway when we swallow something, and also form the sounds we know as speech and song. The sounds the cords are able to make can vary widely. Think about the differences between the music produced by a rock singer and an operatic soprano, for example, or the yell of a sports fan and a whisper to a baby.

When the vocal cords are in use for speech or singing they vibrate rapidly, with their free margins repeatedly striking each other; the vibrations can be as often as hundreds of times per minute. Voices can differ in timber (think about the same note played on a clarinet and violin, for example), pitch (whether the sound is high or low), and resonance (imagine how your voice sounds when you have a chest cold or sinus infection compared to normal).


Like all tissues in the body, the laryngeal surfaces are covered by a thin layer carrying oxygen to the tissue through tiny capillaries. All of the tissues are designed to do a lot of work, but vocal tissues are especially vulnerable to damage from factors both inside and outside of the body. Overuse, and sometimes misuse, is common when untrained performers need to hit notes which are not within their natural range, or the volume is too high or prolonged.

Singers and other performers sometimes abuse their voices. Laryngologists work closely with these patients to treat potentially career-threatening problems, and to help them learn techniques to prevent the damage in the first place.

When you think about how the vocal cords work, singers and actors who push their voices beyond their training or comfort zones have the delicate tissues together slamming together hundreds of times per minute. This repeated trauma causes the immune system to respond with swelling, inflammation and pain. Mucus forms to try to protect the tissues, hoarseness or even total loss of the voice can happen; polyps or nodules can form. These will pretty much close down a career temporarily, if not permanently.

We’ve all heard of famous performers who had to drop out of sight for weeks or months because of vocal cord nodules or polyps. Nodules are basically lumps on the vocal cords resulting from the repeated trauma, usually one on each side in the center of the cord. Just like in other parts of the body, calluses can form on the damaged areas - the body trying to protect itself again - and these prevent the tight closure of the vocal cords. Voices are hoarse and rough. There may be a sensation of a "lump in the throat". There may be pain, and the pitch range is reduced.

Polyps are similar to nodules in that they are caused by trauma, but they tend to be larger, and usually occur on one side only.

Related pages

Contact Jaime E. Moore, M.D.

VCU Health Systems - Stony Point
9109 Stony Point Drive, Suite 1200
Richmond, VA 23235
Phone: (804) 323-0830 
Fax: (804) 327-8076

VCU Medical Center - Nelson Clinic
401 North 11th Street
Richmond, VA 23219
Phone: (804) 628-4368
Fax: (804) 828-8299

VCU Medical Center Department of Otolaryngology