Vocal Cords

What are vocal cords (vocal folds)?

Your vocal cords are two bands of muscle inside your voice box (larynx) that allow you to vocalize, or make sounds. Your voice box sits atop your windpipe (trachea), the tube that allows air to flow to and from your lungs. When you breathe in (inhale) and breathe out (exhale), your vocal cords open so air can flow freely. When you speak, your vocal cords close by meeting in the middle of your exhaled airstream and vibrate. The vibration creates the sound of your voice.

Most healthcare providers refer to vocal cords as vocal folds. The difference relates to structure. People once thought that vocal cords were like two strings (cords) of a musical instrument that vibrated when strummed or plucked. Now we know that each band consists of multiple folds. These folds aren’t isolated structures, like cords or strings. Instead, they connect to various muscles and cartilage inside of your voice box.

What is the function of vocal cords?

Most importantly, vocal cords produce the one-of-a-kind sound that you (and others) understand as your voice. They have other functions, too.

Your vocal cords protect your airway:

• During swallowing: Your voice box is located at an important intersection, where your throat branches off into your windpipe (where air flows) or your esophagus (where food travels to your stomach). When you’re eating, your vocal cords close to prevent food, liquid or foreign substances from traveling into your windpipe. Your voice box moves when you swallow, directing food and liquid toward your esophagus.
• During coughing: Your vocal cords also protect your airway by coughing if something moves toward your airway that shouldn’t. Coughing helps you clear your airway when you’re sick. Your vocal cords come together every time you cough or clear your throat.

Your vocal cords also:

• Control airflow: Your vocal cords spread apart to allow a steady airstream to flow while you’re inhaling or exhaling.
• Produce sound: Your vocal cords come together when you’re vocalizing — speaking, humming, singing, growling, moaning, whispering, etc. When your vocal cords touch, they keep the air from your windpipe from escaping. This trapped air places pressure on your vocal cords. The tension causes your vocal cords to vibrate as puffs of air slip through. Your vocal cords may vibrate hundreds of times per second depending on your voice’s pitch or how high or low your voice is. The vibration and the air together produce sound.

Structures in your face and mouth, like your soft palate, sinuses, teeth and tongue, work together to fine-tune the volume and sound quality your vocal cords produce.

Where are the vocal cords located?

Your vocal cords are inside your voice box (larynx), which is on top of your windpipe, directly behind your Adam’s apple. Your Adam’s apple is the bony protrusion in the front of your throat at the midpoint. If you place a finger or two on this spot and swallow, you should feel the protrusion move up. If you yawn, you should feel the protrusion move down.

What is the structure of your vocal cords?

Your vocal cords are two pearly white bands of tissue in the center of your voice box. A vocal cord on the right and one on the left meet to form a shape like an upside-down “V” when your vocal cords are open. When they’re closed, they come together to form a slit.

Your vocal cords stretch from the left to the right side of your voice box and from front to back. They connect to muscles and cartilage inside of your voice box that help control the movement of your vocal cords.

What are vocal cords made of?

A moist, protective lining called a mucous membrane covers your vocal cords. Underneath the lining, vocal cords consist of three basic layers:

• An outer layer of cells called the epithelium.
• A middle layer called the lamina propria, which helps your vocal cords move.
• An innermost muscular layer that includes the vocalis muscle and the thyroarytenoid muscles.

What size are vocal cords?

When you’re born, your vocal cords are about 6 to 8 millimeters long. They grow as you age into adulthood. The length and thickness of your vocal cords help determine how high or low your voice is, or your pitch. Thicker vocal cords produce a lower pitch, or a deep voice.

• Men and people assigned male at birth (AMAB): The hormone testosterone thickens and lengthens vocal cords during puberty, producing deeper voices. The average vocal cord length is 1.75 to 2.5 centimeters. These changes are irreversible. This means that people who are transgender and AMAB who receive feminizing hormone therapy continue to have deeper voices unless they work with a speech-language pathologist to adjust their pitch and/or receive voice feminization surgery.
• Women and people assigned female at birth (AFAB): Vocal cords grow somewhat during puberty, so the average length is 1.25 centimeters and 1.75 centimeters. People who are transgender and AFAB who receive testosterone as part of masculinizing hormone therapy experience changes in their vocal cords, like thickening and lengthening. As a result, their voices deepen.

For some people, vocal cords and other muscles inside their larynx shrink and grow weaker with age, making it harder to talk.

What conditions and disorders affect your vocal cords?

The most common conditions that affect your vocal cords include:

• Laryngitis: Laryngitis is swelling, or inflammation, of your vocal cords. It may cause you to lose your voice, or your voice may sound weak, hoarse or raspy. Overusing your vocal cords, infections, smoking and chronic acid reflux (GERD) are all possible causes of laryngitis.
• Vocal cord nodules, polyps and cysts: Vocal cord nodules, polyps and cysts are benign (noncancerous) growths. Nodules and polyps are solid lumps or bumps, and cysts are fluid-filled. They can cause your voice to sound weak or hoarse, or you may completely lose your voice. Benign growths on your vocal cords often result from straining your voice (overusing or misusing your vocal cords). They can have other causes, too, like smoking, sinusitis and allergies.
• Vocal cord paralysis: Vocal cord paralysis prevents you from being able to open and close your vocal cords normally. As a result, you may have trouble speaking, breathing or swallowing. Multiple conditions can cause nerve damage that prevents the muscles in your vocal cords from moving as they should. This may leave your voice sounding breathy or make it hard to cough and clear your throat normally.

Less common conditions include:

• Laryngeal cancer: Laryngeal cancer can form in the structures in your voice box, including your vocal cords.
• Laryngospasm: Laryngospasm happens when your vocal cords suddenly spasm, making breathing or talking difficult. These spasms are unpredictable and usually last less than a minute.
• Muscle tension dysphonia: Muscle tension dysphonia happens when there’s increased muscle activity in your head and neck. You tighten your muscles either inside of your voice box, outside of your voice box, or both. The tightness prevents your vocal cords from moving freely and easily, and can lead to strain and discomfort in your throat and/or neck. This can happen alone (primary MTD) or as a response to another issue in your voice box (secondary MTD).
• Reinke’s edema: Reinke’s edema occurs when fluid collects in the part of your vocal folds called Reinke’s space, causing them to swell. This can make your voice hoarse and lower in pitch.
• Spasmodic dysphonia: Spasmodic dysphonia is a long-term condition that causes your vocal cords to tighten or spasm when you try to talk.
• Inducible laryngeal obstruction (ILO):This condition makes it difficult to open your vocal cords, making breathing hard. It’s also called vocal cord dysfunction.

What are common signs and symptoms of conditions affecting your vocal cords?

Symptoms depend on the specific condition affecting your vocal cords. They may include:

• Hoarseness.
• Losing your voice.
• A weakened or quieter voice.
• Voice changes, especially going from a higher to a lower pitch or developing a rasp.
• Frequent coughing, swallowing or neck pain.
• Trouble swallowing, talking or breathing.

What common tests are used to check your vocal cords?

Visit a healthcare provider if you have voice changes that last longer than two weeks, like hoarseness or fatigue. Depending on your symptoms, you may need to see a voice specialist or an ear, nose and throat specialist (ENT) for a diagnosis. You may need to see a laryngologist, a specialist who treats disorders affecting the voice box. You may also see a voice-specialized speech-language pathologist.

During your visit, a healthcare provider will ask about your medical history and perform a physical exam. Additional tests and procedures may include a:

• CT scan or MRI: These imaging procedures can reveal structures inside your throat like nodules, polyps or cysts.
• Bacteria culture test: A healthcare provider may swab your throat and test the sample for bacteria that cause infections.
• Laryngoscopy: During this procedure, a provider inserts a thin, lighted instrument called a laryngoscope into your voice box to inspect your vocal cords.
• Videostroboscopy: This procedure is like a laryngoscopy. It involves a special light that allows your healthcare provider to see how your vocal cords vibrate.
• Biopsy: A healthcare provider may remove a tissue sample from your vocal cords to test for abnormal cells.
• Laryngeal electromyography (LEMG): This test can help diagnose vocal cord paralysis. It measures how your nerves control the muscles in your voice box.

What are common treatments for conditions affecting your vocal cords?

Common treatments include:

• Resting your voice by not speaking or singing (vocal rest).
• Medicines that reduce inflammation and pain.
• Surgery to remove growths.
• Voice therapy to help your vocal cords heal or to teach you how to use them properly.

Voice therapy can help you speak more confidently and with greater control. It can also be a treatment for those whose gender identity differs from their sex assigned at birth. This voice therapy is called gender-affirming voice modification training or gender-affirming voice therapy.

What simple lifestyle changes can keep your vocal cords healthy?

The best way to keep your vocal cords healthy is to use them correctly without stressing or straining them.

Don’t:

• Strain your voice by talking or singing too much.
• Speak or sing if your voice sounds hoarse or feels weak.
• Smoke or vape or expose yourself to second-hand smoke.
• Spend too much time yelling or whispering. Spending too much time at either extreme can strain your vocal cords.

Do:

• Get treated for LPRD/GERD if you have it.
• Stay hydrated by drinking enough fluids daily.
• Use a microphone if you need to project your voice.
• Avoid environments where you’re inhaling lots of dust or strong chemicals.
• Reduce how much you’re talking (and how loudly) if you have an infection.
• Practice breathing low into your body when you inhale during speaking and singing. Avoid inhaling while lifting your chest.
• Use a humidifier to keep the air you breathe moist, especially in dry climates and seasons (like winter).

A note from Cleveland Clinic

Your vocal cords allow you to speak, sing and even breathe. Although they’re small, your vocal cords allow friends and family members to recognize who you are by the sound they make when they vibrate. Protect your vocal cords from strain. Don’t overwork your vocal cords by speaking or singing for too long or too loudly. Avoid smoke (including second-hand smoke), and drink plenty of fluids. Keep your voice healthy by being mindful not to abuse your vocal cords.