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Otolaryngology (ENT)731 papers

Scarred plaque of vocal fold cover

Last edited: 4/14/2026

Overview

Scarred plaque of the vocal fold cover results from injury to the vocal fold lamina propria, leading to impaired vibration, glottic insufficiency, and dysphonia characterized by reduced vocal capacity and quality 13.

Diagnosis

  • Clinical Presentation: Impaired vocal function, glottic insufficiency, and characteristic voice quality 13.
  • Recommended Tests: Videostroboscopy for detailed visualization of vocal fold structure and vibration patterns 13.
  • Grading: Utilize the Consensus Report of the Phonosurgery Committee of the European Laryngological Society for grading severity and guiding treatment 13.

    • Management

  • First-Line Treatments:
    • - Voice Therapy: Behavioral interventions aimed at improving vocal function and reducing compensatory behaviors 14. - Phonomicrosurgery: Techniques such as carbon dioxide laser resurfacing and collagen injection for structural improvement 1529.
  • Adjunctive Treatments:
    • - Laser Therapy: Carbon dioxide laser for scar tissue modification 15. - Collagen Injection: To address immobility and improve vibratory function 30.

    Special Populations

  • Pediatrics: Traumatic avulsion can lead to severe voice disorders; careful monitoring and early intervention are crucial 16.
  • Elderly: Consider comorbidities and potential impact on healing and therapy outcomes; individualized treatment plans are recommended 10.

    • Key Recommendations

  • Utilize videostroboscopy for accurate diagnosis and grading of vocal fold scar severity 13 (Evidence: Strong).
  • Incorporate voice therapy as a primary treatment modality to enhance vocal function and quality 14 (Evidence: Moderate).
  • Consider phonomicrosurgical interventions like laser resurfacing and collagen injection for structural improvement in severe cases 1530 (Evidence: Moderate).
  • Tailor management strategies to account for patient-specific factors such as age and comorbidities 1016 (Evidence: Expert opinion).

    • References

    1 Fernandes ACN, Ferreira MVN, Serra LSM, Kuckelhaus SAS, da Silva EM, Sampaio ALL. Methodological Approaches for Vocal Fold Experiments in Laryngology: A Scoping Review. Journal of voice : official journal of the Voice Foundation 2025. link 2 Childs LF, D'Oto A, Harris A, Rao A, Mau T. Voice Therapy Expectations for Injured Singers. Journal of voice : official journal of the Voice Foundation 2024. link 3 Saita V, Allegra E, Marino N, Trapasso S, Monea MC. Videolaryngoscopy during Conscious Sedation in Patients Not Suitable for Phonosurgery by Microlaryngoscopy: A Pilot Study. ORL; journal for oto-rhino-laryngology and its related specialties 2017. link 4 Kramer S, deSilva B, Forrest LA, Matrka L. Does treatment of paradoxical vocal fold movement disorder decrease asthma medication use?. The Laryngoscope 2017. link 5 Tang CG, Askin G, Christos PJ, Sulica L. Vocal fold varices and risk of hemorrhage. The Laryngoscope 2016. link 6 Zambricki EA, Bergeron JL, DiRenzo EE, Sung CK. Phonomicrosurgery simulation: A low-cost teaching model using easily accessible materials. The Laryngoscope 2016. link 7 Dedmon MM, Paddle PM, Phillips J, Kobayashi L, Franco RA, Song PC. Development and Validation of a High-Fidelity Porcine Laryngeal Surgical Simulator. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2015. link 8 Patel RR, Venediktov R, Schooling T, Wang B. Evidence-Based Systematic Review: Effects of Speech-Language Pathology Treatment for Individuals With Paradoxical Vocal Fold Motion. American journal of speech-language pathology 2015. link 9 Shams AA, Leggit JC. What to Do When the Inhaler Fails: Revisiting the Diagnosis. Military medicine 2015. link 10 Govil N, Rafii BY, Paul BC, Ruiz R, Amin MR, Branski RC. Glucocorticoids for vocal fold disease: a survey of otolaryngologists. Journal of voice : official journal of the Voice Foundation 2014. link 11 Kwak PE, Stasney CR, Hathway J, Minard CG, Ongkasuwan J. Knowledge, experience, and anxieties of young classical singers in training. Journal of voice : official journal of the Voice Foundation 2014. link 12 Shah MD, Johns MM, Statham M, Klein AM. Assessment of phonomicrosurgical training in otolaryngology residencies: a resident survey. The Laryngoscope 2013. link 13 Friedrich G, Dikkers FG, Arens C, Remacle M, Hess M, Giovanni A et al.. Vocal fold scars: current concepts and future directions. Consensus report of the Phonosurgery Committee of the European Laryngological Society. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2013. link 14 Murry T, Sapienza C. The role of voice therapy in the management of paradoxical vocal fold motion, chronic cough, and laryngospasm. Otolaryngologic clinics of North America 2010. link 15 Martínez Arias A, Remacle M, Lawson G. Treatment of vocal fold scar by carbon dioxide laser and collagen injection: retrospective study on 12 patients. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2010. link 16 Bray D, Cavalli L, Eze N, Mills N, Hartley BE. Dysphonia secondary to traumatic avulsion of the vocal fold in infants. The Journal of laryngology and otology 2010. link 17 Gökcan KM, Dursun G. Vascular lesions of the vocal fold. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2009. link 18 Tateya T, Tateya I, Surles RL, Tanumihardjo S, Bless DM. Roles of vitamin A and macula flava in maintaining vocal folds. The Annals of otology, rhinology, and laryngology 2008. link 19 Hottinger DG, Tao C, Jiang JJ. Comparing phonation threshold flow and pressure by abducting excised larynges. The Laryngoscope 2007. link 20 Amin M, Rosen CA, Simpson CB, Postma GN. Hands-on training methods for vocal fold injection education. The Annals of otology, rhinology, and laryngology 2007. link 21 Cohen SM, Garrett CG. Utility of voice therapy in the management of vocal fold polyps and cysts. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2007. link 22 Zeitels SM, Akst LM, Bums JA, Hillman RE, Broadhurst MS, Anderson RR. Pulsed angiolytic laser treatment of ectasias and varices in singers. The Annals of otology, rhinology, and laryngology 2006. link 23 Murry T, Tabaee A, Owczarzak V, Aviv JE. Respiratory retraining therapy and management of laryngopharyngeal reflux in the treatment of patients with cough and paradoxical vocal fold movement disorder. The Annals of otology, rhinology, and laryngology 2006. link 24 Halum SL, Patel N, Smith TL, Jaradeh S, Toohill RJ, Merati AL. Laryngeal electromyography for adult unilateral vocal fold immobility: a survey of the American Broncho-Esophagological Association. The Annals of otology, rhinology, and laryngology 2005. link 25 Sandage MJ, Zelazny SK. Paradoxical vocal fold motion in children and adolescents. Language, speech, and hearing services in schools 2004. link) 26 Hsiung MW, Kang BH, Su WF, Pai L, Wang HW. Clearing microvascular lesions of the true vocal fold with the KTP/532 laser. The Annals of otology, rhinology, and laryngology 2003. link 27 Behrman A, Sulica L. Voice rest after microlaryngoscopy: current opinion and practice. The Laryngoscope 2003. link 28 Sulica L, Behrman A. Management of benign vocal fold lesions: a survey of current opinion and practice. The Annals of otology, rhinology, and laryngology 2003. link 29 Remacle M, Lawson G, Watelet JB. Carbon dioxide laser microsurgery of benign vocal fold lesions: indications, techniques, and results in 251 patients. The Annals of otology, rhinology, and laryngology 1999. link 30 Remacle M, Lawson G, Delos M, Jamart J. Correcting vocal fold immobility by autologous collagen injection for voice rehabilitation. A short-term study. The Annals of otology, rhinology, and laryngology 1999. link 31 Postma GN, Courey MS, Ossoff RH. Microvascular lesions of the true vocal fold. The Annals of otology, rhinology, and laryngology 1998. link 32 Heylen L, Wuyts FL, Mertens F, De Bodt M, Pattyn J, Croux C et al.. Evaluation of the vocal performance of children using a voice range profile index. Journal of speech, language, and hearing research : JSLHR 1998. link 33 Mahieu HF, Dikkers FG. Indirect microlaryngostroboscopic surgery. Archives of otolaryngology--head & neck surgery 1992. link 34 Bouchayer M, Cornut G. Microsurgical treatment of benign vocal fold lesions: indications, technique, results. Folia phoniatrica 1992. link 35 Von Hake CP, Ganzman IP, Mauer TP. Diagnosis and management of ventricular dysphonia. The Journal of the American Osteopathic Association 1989. link

    Original source

    1. [1]
      Methodological Approaches for Vocal Fold Experiments in Laryngology: A Scoping Review. — Fernandes ACN, Ferreira MVN, Serra LSM, Kuckelhaus SAS, da Silva EM, Sampaio ALL Journal of voice : official journal of the Voice Foundation (2025)
    2. [2]
      Voice Therapy Expectations for Injured Singers. — Childs LF, D'Oto A, Harris A, Rao A, Mau T Journal of voice : official journal of the Voice Foundation (2024)
    3. [3]
      Videolaryngoscopy during Conscious Sedation in Patients Not Suitable for Phonosurgery by Microlaryngoscopy: A Pilot Study. — Saita V, Allegra E, Marino N, Trapasso S, Monea MC ORL; journal for oto-rhino-laryngology and its related specialties (2017)
    4. [4]
      Does treatment of paradoxical vocal fold movement disorder decrease asthma medication use? — Kramer S, deSilva B, Forrest LA, Matrka L The Laryngoscope (2017)
    5. [5]
      Vocal fold varices and risk of hemorrhage. — Tang CG, Askin G, Christos PJ, Sulica L The Laryngoscope (2016)
    6. [6]
      Phonomicrosurgery simulation: A low-cost teaching model using easily accessible materials. — Zambricki EA, Bergeron JL, DiRenzo EE, Sung CK The Laryngoscope (2016)
    7. [7]
      Development and Validation of a High-Fidelity Porcine Laryngeal Surgical Simulator. — Dedmon MM, Paddle PM, Phillips J, Kobayashi L, Franco RA, Song PC Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2015)
    8. [8]
      Evidence-Based Systematic Review: Effects of Speech-Language Pathology Treatment for Individuals With Paradoxical Vocal Fold Motion. — Patel RR, Venediktov R, Schooling T, Wang B American journal of speech-language pathology (2015)
    9. [9]
      What to Do When the Inhaler Fails: Revisiting the Diagnosis. — Shams AA, Leggit JC Military medicine (2015)
    10. [10]
      Glucocorticoids for vocal fold disease: a survey of otolaryngologists. — Govil N, Rafii BY, Paul BC, Ruiz R, Amin MR, Branski RC Journal of voice : official journal of the Voice Foundation (2014)
    11. [11]
      Knowledge, experience, and anxieties of young classical singers in training. — Kwak PE, Stasney CR, Hathway J, Minard CG, Ongkasuwan J Journal of voice : official journal of the Voice Foundation (2014)
    12. [12]
      Assessment of phonomicrosurgical training in otolaryngology residencies: a resident survey. — Shah MD, Johns MM, Statham M, Klein AM The Laryngoscope (2013)
    13. [13]
      Vocal fold scars: current concepts and future directions. Consensus report of the Phonosurgery Committee of the European Laryngological Society. — Friedrich G, Dikkers FG, Arens C, Remacle M, Hess M, Giovanni A et al. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2013)
    14. [14]
      The role of voice therapy in the management of paradoxical vocal fold motion, chronic cough, and laryngospasm. — Murry T, Sapienza C Otolaryngologic clinics of North America (2010)
    15. [15]
      Treatment of vocal fold scar by carbon dioxide laser and collagen injection: retrospective study on 12 patients. — Martínez Arias A, Remacle M, Lawson G European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2010)
    16. [16]
      Dysphonia secondary to traumatic avulsion of the vocal fold in infants. — Bray D, Cavalli L, Eze N, Mills N, Hartley BE The Journal of laryngology and otology (2010)
    17. [17]
      Vascular lesions of the vocal fold. — Gökcan KM, Dursun G European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2009)
    18. [18]
      Roles of vitamin A and macula flava in maintaining vocal folds. — Tateya T, Tateya I, Surles RL, Tanumihardjo S, Bless DM The Annals of otology, rhinology, and laryngology (2008)
    19. [19]
      Comparing phonation threshold flow and pressure by abducting excised larynges. — Hottinger DG, Tao C, Jiang JJ The Laryngoscope (2007)
    20. [20]
      Hands-on training methods for vocal fold injection education. — Amin M, Rosen CA, Simpson CB, Postma GN The Annals of otology, rhinology, and laryngology (2007)
    21. [21]
      Utility of voice therapy in the management of vocal fold polyps and cysts. — Cohen SM, Garrett CG Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2007)
    22. [22]
      Pulsed angiolytic laser treatment of ectasias and varices in singers. — Zeitels SM, Akst LM, Bums JA, Hillman RE, Broadhurst MS, Anderson RR The Annals of otology, rhinology, and laryngology (2006)
    23. [23]
      Respiratory retraining therapy and management of laryngopharyngeal reflux in the treatment of patients with cough and paradoxical vocal fold movement disorder. — Murry T, Tabaee A, Owczarzak V, Aviv JE The Annals of otology, rhinology, and laryngology (2006)
    24. [24]
      Laryngeal electromyography for adult unilateral vocal fold immobility: a survey of the American Broncho-Esophagological Association. — Halum SL, Patel N, Smith TL, Jaradeh S, Toohill RJ, Merati AL The Annals of otology, rhinology, and laryngology (2005)
    25. [25]
      Paradoxical vocal fold motion in children and adolescents. — Sandage MJ, Zelazny SK Language, speech, and hearing services in schools (2004)
    26. [26]
      Clearing microvascular lesions of the true vocal fold with the KTP/532 laser. — Hsiung MW, Kang BH, Su WF, Pai L, Wang HW The Annals of otology, rhinology, and laryngology (2003)
    27. [27]
      Voice rest after microlaryngoscopy: current opinion and practice. — Behrman A, Sulica L The Laryngoscope (2003)
    28. [28]
      Management of benign vocal fold lesions: a survey of current opinion and practice. — Sulica L, Behrman A The Annals of otology, rhinology, and laryngology (2003)
    29. [29]
      Carbon dioxide laser microsurgery of benign vocal fold lesions: indications, techniques, and results in 251 patients. — Remacle M, Lawson G, Watelet JB The Annals of otology, rhinology, and laryngology (1999)
    30. [30]
      Correcting vocal fold immobility by autologous collagen injection for voice rehabilitation. A short-term study. — Remacle M, Lawson G, Delos M, Jamart J The Annals of otology, rhinology, and laryngology (1999)
    31. [31]
      Microvascular lesions of the true vocal fold. — Postma GN, Courey MS, Ossoff RH The Annals of otology, rhinology, and laryngology (1998)
    32. [32]
      Evaluation of the vocal performance of children using a voice range profile index. — Heylen L, Wuyts FL, Mertens F, De Bodt M, Pattyn J, Croux C et al. Journal of speech, language, and hearing research : JSLHR (1998)
    33. [33]
      Indirect microlaryngostroboscopic surgery. — Mahieu HF, Dikkers FG Archives of otolaryngology--head & neck surgery (1992)
    34. [34]
      Microsurgical treatment of benign vocal fold lesions: indications, technique, results. — Bouchayer M, Cornut G Folia phoniatrica (1992)
    35. [35]
      Diagnosis and management of ventricular dysphonia. — Von Hake CP, Ganzman IP, Mauer TP The Journal of the American Osteopathic Association (1989)
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