Bowing of the vocal cords

This is a descriptive term to specify that the vocal cords are not matching in a straight line, with only a thin dark line between them at the moment of pre-phonation. Instead, the cords become gently concave or bowed outwards. At the moment of pre-phonation, there is a wider, oval slit between the cords.

Bowing can be physiologic, asymptomatic, and a genetic “given.” In this physiologic type, the bowing will be subtle to mild and there will be good vibratory pattern. When moderate or severe, bowing may more likely be the result of aging, vocal disuse, Parkinson’s disease, or other conditions. Moderate and severe bowing correlate with a degree of vocal cord atrophy and the vibratory pattern can be more flaccid. The voice tends to have a soft-edged quality, a little higher in pitch than normal, and can fade with use. Voice building is the primary treatment, but very occasionally severe bowing is treated with bilateral vocal cord implants.


Photos:

Vocal Cord Bowing

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Vocal cord bowing

Vocal cord bowing (1 of 4)

Open phase vibration, strobe light. Notice the large amplitude of vibration. The wide lateral excursions suggest flaccidity, especially when this is seen in middle voice.
anterior cords are more flaccid, with delayed return to midline contact

Vocal cord bowing (2 of 4)

Partially closed phase. Notice that the anterior cords (arrows) are more flaccid, with delayed return to midline contact. When this is seen, that anterior segment may vibrate independently and cause a rough, gravelly voice quality. The capillary ectasia, left vocal cord (right of image), is an incidental finding and not related to the patient’s rough voice quality.
persistent anterior open segment

Vocal cord bowing (3 of 4)

Coming to closed phase, but with the persistent anterior open segment.
Closed phase of vibration.

Vocal cord bowing (4 of 4)

Closed phase of vibration.
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Vocal cords at the prephonatory instant

Vocal cord bowing (1 of 3)

Vocal cords at the prephonatory instant under standard light. Note the highly bowed glottic gap.
vibratory blur consistent with bowing

Vocal cord bowing (2 of 3)

After vibration begins. Note the very wide “vibratory blur,” consistent with bowing under standard light.
Open phase of vibration under strobe light

Vocal cord bowing (3 of 3)

Open phase of vibration under strobe light, showing unusually wide lateral excursions of the cords resulting from their flaccidity.










Voice Building:

Voice Building (shorter version):