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Vocal Fold Scar
Underneath the skin of the vocal fold is a special tissue layer—called Reinke’s layer or the superficial lamina propria—that permits the vocal fold cover to vibrate over the underlying tissue. Any disruption of this layer causes abnormal vibration and a change in the voice. Often this is caused by scar tissue due to a vocal abuse or previous trauma to the vocal fold, such as surgery.
• Scarring can be caused by vocal fold lesions that have been present for a long time and grown into deeper tissue, from generalized inflammation of the vocal folds, a vocal fold hemorrhage, radiation used to treat cancer, or from surgery on the vocal folds.
• Scarring means that the mucosa is tethered to the underlying tissue and cannot vibrate freely. The resulting irregularities in vibration cause symptoms such as hoarseness and breathiness, and demand increased effort or strain to produce voice.
• Diagnosis is made by taking a patient’s history and performing a video stroboscopy.
• Treatment & Prognosis: Surgically repairing a scar is very challenging. Due to this, the first treatment is generally voice therapy to improve the efficiency of the voice in the face of the scar. Often this is enough. If not, multiple surgical treatments are available, including steroid injections and vocal fold augmentation. At the Voice and Swallowing Institute, we believe surgery that includes transplantation of the cover of a muscle into the area of the scar offers the best treatment result at this time. We are currently performing research on a new implantable material that may be an improvement on what is now available. There are likely to be some permanent changes in vocal quality.
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