The vocal cords are muscles covered with a lining of mucous membrane. The vocal muscles form a slit whose sides come together up to 200 times per second as air is forced up from the lungs, thus producing the voice. If there is any problem with the muscles or with the lining, one gets hoarse. Exposure to air conditioning or mouth breathing causes dryness which makes the vocal cords vulnerable.
Shouting makes the cords hit each other with excessive force, thereby producing localized sites of injury which then causes the growth of nodules, polyps or granulomas.
All age groups can be involved. Children who misuse their voice often present with vocal nodules (also known as Singer’s nodules). Cysts of the cords are not uncommon and their growth causes persistent hoarseness.
In the elderly a common cause of intermittent hoarseness it the atrophy or loss of muscle bulk of the vocal cords, which do not appose properly, resulting in air escape. Excessive tension or spasm of the laryngeal muscles gives hoarseness as well. Speech therapy or voice therapy plays an important role in the rehabilitation of benign vocal cord conditions.
Smokers often have swelling of the mucous membrane overlying the vocal cords (Reinke’s oedema) which gives the voice in heavy smokers its characteristic ‘brassy’ character. Precancerous and cancerous change in the vocal cords may occur even after the patient has stopped smoking. ENT doctors have to biopsy suspicious looking areas of the vocal cords to make sure that no precancerous change is taking place.