Vocal cord disorders

Vocal cord disorders arise as acute or as chronic and long-term diseases that affect this major phonatory organ in humans. Due to the rather extensive structure of the vocal cords, there are several types of inflammatory, non-inflammatory, tumor, cystic and other types of diseases or pathological conditions that can affect the vocal cords. Sometimes these are only diseases related to the vocal cords, other times they are diseases of the larynx or pharynx that cross over into the vocal cords and disrupt their functions or tissues.

Some diseases are caused by uncaused causes and are various infectious or inflammatory diseases of the vocal cords, but many pathologies are related to external factors that a person can control, for example, smoking, which causes the typical thickening of the voice. In fact, the depth, pitch and colour of the voice are influenced by the vibration of the vocal cords themselves and also by the anatomy and shape of the larynx and resonant cavities, so that several diseases of the larynx also directly affect the function and structure of the vocal cord tissue.

These are located in the larynx and are composed of several structures that are involved in the final process of voice production. Vocal cord disorders cords may be related, for example, to inflammation in the larynx, respiratory diseases where there is a transfer of infection and inflammation from nearby and adjacent tissues, various oedemas, abscesses, paralyses, both temporary and permanent, and various diseases disturbing the original anatomy or tissue of the vocal cords, which mainly affect the phonatory function of the organ.

Anatomy of the vocal cords

The medical term for the vocal cords is the glottis, and it is a narrowed area in the middle of the larynx that is bordered by two vocal cilia that can move anteriorly. The sound produced in this sagittal slit by the airflow of these two vocal cilia is then resonated in the upper cavities such as the larynx, pharynx, oral cavity, nasal cavity and sinuses, thus giving the voice its characteristic colour, which is individual for each person.

The deeper male voice is due to a larger and more spacious larynx and longer vocal cords. The vocal cords themselves consist of the vocal cord muscle, which connects the cartilaginous cartilages, and the slit between the vocal cords allows airflow. This flow through the cartilages allows the movement of the vocal folds themselves, which move closer and farther apart to create sound. The ligaments and muscles of the vocal cords are stretched between the cartilaginous process and the posterior margin of the thyroid cartilage.

The sound is produced by exhaling as the vocal folds approach, with air hitting the vocal folds and repelling the air away from the vocal folds. However, due to their great elasticity, the eyelashes return immediately to their original position towards each other, flutter and periodically interrupt the flow of air that is exhaled. Based on the resonant frequency of the oscillating vocal cords, a specific tone of voice is then produced. The frequency is highest in children at over 300 Hz, in women at around 210 Hz and in men at around 125 Hz, i.e. men have the thickest voice.

The vocal cord cilia themselves are flexible due to the fact that the process is made up of elastic cartilage. The vocal cord ligament is also made of elastic fibers and serves as a support for the softer cilia, which are formed by the folds of the mucous membrane. The ligament affects the striated vocal cord muscle, which can be influenced by volition, and it is the tension of the muscle that causes the vocal cord eyelashes to move closer together and hence the tones of the voice.

Inflammatory diseases

Inflammatory diseases very often affect the vocal cords as well as the whole larynx. For example, acute inflammation of the larynx and vocal cords, which can take several forms, namely edematous, subglottic, purulent or ulcerative. These inflammatory diseases also include acute obstructive laryngitis, laryngitis, unspecified obstructive laryngitis and unspecified epiglottitis. The most common inflammations affecting the larynx and vocal cords are laryngitis, which can be acute, chronic and specific.

Acute laryngitis includes acute epiglottitis, acute subglottic laryngitis and acute catarrhal laryngitis. Chronic laryngitis can be atrophic and hypertrophic, depending on whether there is shrinkage or enlargement of the affected structures. Specific inflammations of the larynx that also affect the vocal cords include laryngeal tuberculosis and laryngeal syphilis, but these affect the vocal cords only in a minority of rare cases. Usually, inflammation is manifested by hoarseness, hoarseness and voice problems.

Common laryngitis is caused by inflammation or infection, most often arising from a microbiotic viral or bacterial infection and causing severe scratching in the throat, sometimes coughing and mucus production, and especially hoarseness, leading to temporary or, in some forms of chronic inflammation, long-term side or weakening of the voice and vocal cords. In chronic forms, there is long-term inflammation of the laryngeal lining, most notably in the region of the vocal cords.

Acute laryngitis has a relatively rapid onset of symptoms and the onset of the disease is within a few hours, in which case the inflammation can be caused, for example, by vocal strain, irritation of the vocal cords, for example, chemically or mechanically, or excessive cold. Most often such inflammation is manifested by hoarseness, but here it is necessary to distinguish whether it is just a common cold or a more serious cause. Some acute forms, such as epiglottitis, may also be life-threatening with great swelling of the vocal cords and larynx.

Tumours of the vocal cords

The vocal cords, like the larynx and other associated tissues, are also affected by tumours. These can take different forms and are either benign or malignant tumours or malignant tumours of a cancerous type. The most common cancer of the vocal cords occurs in men over 60 years of age, and there is a strong correlation between the development of cancerous tumours and excessive and prolonged use of alcoholic beverages and smoking.

However, tumours also arise from other causes or from the action of various physical, chemical and biological factors. Physical risk factors include X-ray irradiation, chemical risk factors include smoking, cigarette smoke, alcohol, fats and certain preservatives, and biological risk factors include various viruses and other micro-organisms. While benign tumours grow more slowly and do not metastasise, malignant tumours are very aggressive, invasive and take many forms.

Papilloma is the most common type of benign tumour affecting both the larynx and the vocal cords. It is a tumour arising from the surface epithelium and is most commonly caused by the human HPV virus, or papilloma virus. In children, papillomatosis also occurs when there is an accumulation of multiple papillomas locally in one site. Although this is a benign and non-aggressive type of tumour, it has a high recurrence rate and returns to its original site even after removal.

The epithelium and lining of the larynx also give rise to malignant tumours causing cancer, which, according to their location, take three forms, namely glottic cancer, supraglotic cancer and infraglotic cancer. The first type begins with tumour growth on one vocal cord, the second type spreads from the laryngeal appendage and the third type grows from surrounding structures. Glottic cancer affects the vocal cords most specifically and progresses slowly, so at the time of diagnosis many times it may not even have metastasized yet, improving the prognosis for treatment.

Polyps, ulcers and nodules of the vocal cords

Among the various benign pseudotumours appearing either directly on the vocal cords or in the larynx, there are also various polyps, ulcers, cyst-like formations, nodules and the like. It is these formations that most often manifest themselves as voice and hoarseness problems, while some initially benign formations may also turn malignant or, at least significantly, impair the function of the vocal cords. The most common problem is nodules that form on the vocal cords when they are overstressed for a long time.

These are solid formations arising on the edge of the vocal cords and most often afflict people who constantly use their vocal cords at work, but on the other hand, they can also occur in children, especially if they have overused their vocal cords for a long time. The nodules are most often found on both sides of the vocal cords and in the same places, so they also touch. They can be either softer, which are young, or harder, which are old. They are most often in the middle part of the vocal cords and formed by a thickened layer of mucous membrane.

Polyps arise in the vocal cords as soft and small growths most often caused by prolonged exposure of the larynx and vocal cords to cigarette or other irritants. However, they can also arise after an allergic reaction or when the voice is overstrained by improper voice production technique. Unlike nodules, they are most often unilateral, reddened and well vascularised and cause various vocal problems, hoarseness and, in cases of larger polyps, breathing difficulties.

Among the less common diseases and disorders of the vocal cords can also be found cysts and ulcers. Cysts are hard masses hidden under the mucous membrane and cause problems with the voice as well as breathing. Ulcers, on the other hand, arise on the mucous membrane and are disorders of erosion in the vocal cords, which occur most often due to great force and exertion of the vocal cords. In some cases they may also be caused by heartburn, and this is due to the chronic action of acid stomach acids which irritate the larynx.

Other vocal cord disorders

In addition to inflammatory, cancerous and various ulcerative or polyp diseases, some lesser known, but certainly not rare or simple diseases affect the vocal cords and larynx. These include vocal cord and laryngeal paralyses such as laryngoplegia. In addition, various fibrous formations may also form on the vocal cords. The larynx is affected, for example, by stenosis, abscess, spasm, pachydermia, necrosis, perichondritis, ulcer or even cellulitis.

Similarly, the vocal cords, which are covered with mucous membranes, may develop various formations of a pathological nature, such as an abscess, cellulitis, granuloma, leukokeratosis or leukoplakia. The larynx is also affected by oedemas, such as vocal cord oedema, subglottic or supraglottic oedema, depending on the part of the larynx in which it is located. Several other diseases of the larynx or oral cavity are also related to the larynx as they affect it either directly or indirectly.

Problems with the larynx or vocal cords are usually manifested by problems with the voice and sounds, and in more advanced stages there is also hoarseness or coughing and pain in the throat area. However, in some acute and sub-acute forms of laryngeal diseases, there is also a risk to life, as breathing may be difficult or impossible, due to the threat to the passage of air through the larynx and vocal cords if there is a pathological formation and body.