Conditions: Voice

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How does the larynx work?

The larynx, also known as the voice box, performs important roles in the generation of sound and speech, in swallowing, and in breathing. Positioned in the neck, specifically between the base of the tongue and the top of the trachea, the larynx consists of various anatomic structures that work harmoniously. When we speak, air expelled from the lungs passes throughthe larynx with the vocal cords closed. Within the larynx, the vocal folds, situated on either side, vibrate against each other as air flows past them, creating sound waves. The pitch of our voice is determined by the tension and length of these folds. As we modulate our voices, muscles within the larynx adjust the position of the vocal folds, altering the pitch, volume, and quality of our speech.

During breathing, the vocal cords open to allow air to pass to and from the lungs.

Additionally, the larynx acts as a crucial guardian of the lower airway, preventing food from entering the trachea and directing it toward the esophagus.

The nerves of the larynx

The nerves of the larynx are the superior laryngeal nerve and the recurrent laryngeal nerve. The superior laryngeal nerve carries sensory fibers to the larynx, while the external branch of this nerve supplies the cricothyroid muscle, responsible for adjusting vocal cord tension during speech, and allowing one to reach a high pitch voice. The recurrent laryngeal nerve controls all of the laryngeal muscles other than the cricothyroid muscle. These muscles move the pieces of the cartilage framework of the larynx for speech, breathing, and swallowing, including the abduction (opening) of the vocal cords for maximal airway and the adduction (closing) of the vocal cords for making noise for speech.

These nerves have a somewhat variable anatomic course from person to person.

Vocal strain

Hoarseness after yelling at a sports event is just one extreme example of vocal strain. More commonly, people who unknowingly develop habits of using their voice that are harsh on the vocal cords, or people who talk a lot, will develop hoarseness. And when people strain to overcome this hoarseness, the problem worsens, creating a downward cycle.

Muscle tension dysphonia

Muscle tension dysphonia (MTD) is a category of hoarseness (dysphonia) characterized by increased muscle tension of the muscles surrounding the voice box and leading to a breathy or harsh voice. This condition arises as multiple factors (including personal temperament, increased vocal use, and underlying medical or physical causes) cause the muscles of the larynx to become tense. This changes the position of the larynx and affects the cartilaginous structures within the larynx leading to abnormal voice production (phonation). Unlike spasmodic dysphonia (described below), MTD affects all vocal tasks (talking, singing). MTD may be the result of a medical condition (such as reflux, a vocal nodule, and post-menopausal hormone levels) or it may be without identifiable physical cause. Diagnosis is made by an otolaryngologist and/or a speech pathologist. Listening to the voice during different vocal tasks, finding elevation of the thyroid cartilage on palpation and seeing a gap between the vocal cords toward the back of the larynx when viewed with a scope are among the examination findings supporting the diagnosis, helping to differentiate MTD from other dysphonias.