Vocal Fold Bowing

Vocal Fold Bowing

Anatomy of the Condition

The vocal folds are inside the larynx or voice box. These structures open for breathing. They come together during swallowing. They vibrate as air passes between them during speaking or singing. Fine layers with a soft outer cover make up the vocal folds. A stiffer ligament lies below the thyroarytenoid muscle connects deep to the ligament. The thyroarytenoid muscle makes up the bulk of the vocal fold.

When one or both of the vocal folds become atrophied or weak, a gap forms between the vocal folds. This causes vocal fold bowing. It prevents them from closing completely and vibrating as they should.

Causes or Contributing Factors

Aging of the vocal folds usually causes vocal fold bowing. Viral infections can lead to weakness and atrophy of one or both of the vocal folds.


  • Weakness and breathiness of the voice
  • Hoarseness
  • Strained voice

Diagnosis of Vocal Cord Bowing

Our team will discuss your symptoms and medical history. We will perform a thorough head and neck examination. Our evaluation team often involves several members of the Emory Voice Center. We will assess vocal quality, efficiency, and proper speaking technique.

We may complete a laryngeal videostroboscopy. In this minimally invasive procedure, we use an endoscope (a small tube equipped with a fiber optic camera.) A stroboscopic light source lets us check laryngeal function and vibration.

We may recommend microlaryngoscopy. A physician will examine the vocal folds of the larynx with magnification tools. We conduct this procedure under general anesthesia.


The first step in treating vocal cord bowing is usually non-operative. We begin with voice therapy to exercise and strengthen the vocal cords.

In the event voice therapy does not work or is not appropriate, intervention to plump up the vocal folds may be recommended. Plumping of the vocal folds can be done several ways and helps by improving the ability of the vocal folds to vibrate against each other.

An injection laryngoplasty is a temporary, effective procedure that can be done in the awake setting or under general anesthesia. A resorbable material is injected into the vocal folds to move them closer to each other.

For a more permanent intervention, we may recommend a procedure called a bilateral medialization laryngoplasty. This procedure can be very successful at improving voice problems arising from bowing. We insert implants into the larynx to improve closure and voice.


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