"I can come by here and have a couple of polyps lasered off my vocal cords and then go straight to work."
— Daryl Collins, age 53

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Vocal Fold Bowing

Anatomy of the Condition:

The vocal folds are located within the larynx or voice box. They are structures which open for breathing, 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 cord bowing occurs when one or both of the vocal folds become 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 is usually a result of aging of the vocal folds. Sometimes 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


The physician will ask the patient about symptoms and medical history, followed by a thorough head and neck examination. The examination likely will involve several members of The Emory Voice Center 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.


Non-operative treatment, including voice therapy to exercise and strengthen the vocal cords, is usually the first step in treatment.

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 improve closure and voice.