Anatomy of the Condition:
The vocal folds are located within the larynx or voice box.  They are structures which open for breathing, and come together during swallowing, and vibrate as air passes between them during speaking or singing.  They are made up of fine layers, with a soft outer cover, a stiffer ligament below this, and a muscle called the thyroarytenoid muscle located deep to the ligament.  The thyroarytenoid muscle makes up the bulk of the vocal fold.

Vocal fold bowing occurs when one or both of the vocal folds becomes atrophied or weak and a gap forms between the vocal cords, which prevents them from closing completely and vibrating normally.

Causes or Contributing Factors
Vocal fold bowing can be a simple factor of aging of the vocal folds.  Sometimes viral infections can lead to weakness and atrophy of one or both of the vocal folds. 

Symptoms include:

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

Diagnosis:
The voice team will ask the patient about symptoms and their medical history,
followed by a thorough head and neck examination. The examination likely will involve several members of the voice team to assess vocal quality, efficiency, and proper speaking technique.

Laryngeal videostroboscopy may be required.  This is a procedure using a flexible and/or rigid endoscope coupled to a video monitor and a stroboscopic light source to allow for detailed visual evaluation of laryngeal function and vibration.

Microlaryngoscopy may be required.  It is a procedure conducted under general anesthesia which allows the physician to examine the vocal folds of the larynx with magnification tools. 

Treatment:
Non-operative treatment for vocal fold bowing is usually the first step in treatment.  This treatment involves voice therapy to exercise and strengthen the vocal cords.

In some cases, a procedure called a Bilateral Medialization Laryngoplasty can be very successful at improving voice problems arising from bowing.  It involves inserting implants into the larynx to medialize the vocal folds and improve closure and voice.