Department of Otolaryngology

Vocal Fold Atrophy

Understanding The Disorder

Vocal fold atrophy refers to a gradual change in the vocal folds as people age. The vocal fold muscle can become thinner and/or less taut overtime. The soft outer layer of the vocal folds can also lose bulk over time. These tissue changes affect the ability of the vocal folds to vibrate regularly and can cause an abnormal gap between the vocal folds.

A Continuum

Vocal fold atrophy can range from very mild thinning of the vocal folds to severe loss of muscle bulk. Similarly, the vocal characteristics of a person with vocal fold atrophy can vary greatly.

Difficult to Treat

Vocal fold atrophy is a treatable condition; however, it is not uncommon that patients undergo more than one treatment option. There is currently no treatment that can restore the “taut” tissue quality in the vocal folds; therefore,treatment more often focuses on improving vocal fold muscle bulk and/or optimizing voicing techniques in light of the patient’s anatomical deficit through voice therapy. At present, response to treatment for vocal fold atrophy remains variable.

Stroboscopy Is Key to Diagnosis

Stroboscopic examination of the vocal fold is essential for accurate diagnosis and successful treatment. Stroboscopy is used to quantify the gap between the vocal folds and to evaluate vocal fold vibratory qualities. It is essential in diagnosis and treatment planning.


The most common symptom of vocal fold atrophy is a change in voice quality, ranging from mild to severe. The voice can be affected during speaking, singing or both. Often, roughness/hoarseness will be associated with an increased effort to talk and subsequent fatigue or tiring of the voice with continued use.

Common Symptoms Associated with Vocal Fold Atrophy

  • Inconsistent voice
  • Gravelly/raspy voice
  • Vocal fatigue
  • Difficulty projecting the voice
  • Loss of high range in singing
  • Women with lowering pitch
  • Men with raising of pitch
  • Extra force needed for loud voice
  • Decreased vocal loudness


How is the diagnosis of vocal fold atrophy made?

1. Patient History

a. A history of how the voice problem started and an evaluation of voice and speaking behaviors are important steps in the diagnosis of vocal fold atrophy.

2. Stroboscopy is Key to Diagnosis

a. Careful examination of the vocal folds is essential for making the diagnosis of vocal fold atrophy. Examination is typically performed using a flexible laryngoscope with a stroboscopic light source.

3. Speech-Language Pathology Evaluation

a. Identification of certain voice characteristics are important in identifying the role of vocal fold atrophy compared to abnormalities in muscle coordination in speaking.

b. Speech-language pathologists who specialize in voice disorders are trained to listen to these characteristics to aid in diagnosis, but also to determine the severity of the vocal fold atrophy and if the patient is a good candidate for voice therapy.


What are the treatment options for vocal fold atrophy?

All treatments are aimed at restoring functional voice abilities. Treatment often includes one or more of the following: voice therapy and phonomicrosurgery.

Voice Therapy

Voice therapy helps the patient improve vocal symptoms through techniques geared at improving the way the body (muscles, lungs etc.) work together to create voice. These techniques are geared to help the patient produce voice in the most efficient way possible, despite changes in muscles tissue from vocal fold atrophy. Sometimes, voice therapy is only partially effective due to inherent limitations in the vocal mechanism.


Surgery for vocal fold atrophy aims to restore some of the bulk that has been lost over time. In the case of a gap between the vocal folds due to the loss of muscle and tissue bulk, different materials can be injected into the vocal fold to help close the gap on phonation.