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Mucosal Edema or Swelling

Mucosal edema or swelling is the build-up of edema (tissue fluid) within the mucosa, the layer of tissue that lines the body’s interior. In the larynx, this build-up of edema usually occurs at the mid-point of the vocal cords, as the body’s response to vocal overuse, and it resembles a small, low-profile blister.

Vocal overuse triggers this build-up of edema because, with vocal overuse, the vocal cords undergo more vibratory stress and trauma than they are designed to handle. The body responds by gathering edema to form a protective cushion. However, this swelling distorts the vocal cord’s shape and can limit its flexibility, which can thereby impair the voice, making it sound acutely husky or hoarse.

From Mucosal Edema to Nodules

If the voice is rested even moderately, this edema fluid will disperse rapidly—within 12 to 24 hours if not severe—so that the swelling vanishes and the voice returns to normal. However, if the voice continues to be overused, then the body may build up more chronic swelling materials (no longer just edema), so that the vocal cords develop nodules.

Swelling

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Semi-abducted position

Swelling (1 of 4)

Semi-abducted position, standard light.
Swelling

Swelling (2 of 4)

Pre-phonatory instant. Standard light shows only the suggestion of margin swelling, as the dark space between the cords is not exactly the same along its length
Swelling

Swelling (3 of 4)

Open phase of vibration. Strobe light shows both wide excursions (indicating mild flaccidity) and margin swellings.
Swelling

Swelling (4 of 4)

Closed phase of vibration, strobe light. Shows margin swellings more clearly.

Indicator Swellings

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Pre-phonatory

Pre-phonatory (1 of 4)

Pre-phonatory instant at E-flat 5 (622 Hz), conventional view with standard illumination shows no evident mucosal disorder.
Phonation

Phonation (2 of 4)

Phonation, at E-flat 5 standard illumination, with vibratory blur and still no visible problem.
Subtle swellings

Subtle swellings (3 of 4)

Only at very high pitch and with high magnification can one see subtle swellings. Here, closed phase of vibration at C# 6 (1106 Hz).
Indicator swellings

Indicator swellings (4 of 4)

Open phase of vibration, also at C# 6 . Given the patient’s unimpaired “swelling checks,” these findings serve only as an indicator of past and potential over-use of voice, and should not be explained to the patient as being evidence of past problem and potential future problem if over-use again occurs, but, if voice is functioning well, not necessarily as a current problem.

Indicator Lesions and MTD

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wide gap between the cords

Breathy voice (1 of 6)

Distant view at the prephonatory instant in young female singer. There is a wide gap between the cords. The explanation for this gap is not immediately evident, but the voice is breathy.
Phonation

Phonation (2 of 6)

Phonation has started with margin blurring, and the sense of extra space between the cords remains.
Open phase

Open phase (3 of 6)

Strobe light, open phase of vibration at B4 (494 Hz)
Closed phase

Closed phase (4 of 6)

Closed phase of vibration, still at B4. Note the incomplete closure posteriorly caused by MTD. Arrows indicate the vocal processes.
Open phase, indicator lesions

Open phase, indicator lesions (5 of 6)

Open phase of vibration, strobe light, at F#5 (740 Hz). Here, the subtle indicator lesions are seen more clearly; vocal cord margins are not perfectly straight.
"Closed" phase, MTD

“Closed” phase, MTD (6 of 6)

“Closed” phase of vibration is not really closed and the vocal processes do not come into full closure, again consistent with MTD.

Use High Voice & Close, Clear View to Reveal What Is Concealed

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Breathing position

Breathing position (1 of 4)

Young woman with singing voice complaints. Speaking voice is normal but swelling checks are strongly impaired. Here, breathing position, standard light, nothing is very noticeable except subtle elevation left vocal cord (right of photo).
Phonation

Phonation (2 of 4)

Here, high pitch but under standard light and with only moderate magnification, the abnormality is still fairly unimpressive.
Obvious swellings, open phase

Obvious swellings, open phase (3 of 4)

At closer range, using strobe light, and at the same time using fairly high voice (F#5 740 Hz), the obvious margin swellings are seen.
Obvious swellings, closed phase

Obvious swellings, closed phase (4 of 4)

Same pitch, closed phase of vibration. Now both vocal and visual findings are indeed obvious. After a trial of speech therapy, vocal cord microsurgery provided return of “original equipment” vocal capabilities.

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Vocal Fold Swelling Checks

In this video, Dr. Bastian introduces and demonstrates two swelling checks: two simple vocal exercises that can be used to help detect the early signs of vocal fold injury.

He also discusses the physiology of vocal fold injury and explains how to make the best use of these swelling checks in your daily routine.

5 Symptoms of Vocal Cord Mucosal Injury

Singers or others who have injured the mucosa—surface layer—of their vocal cords may have normal-sounding speaking voices and at the same time, singing voice frustrations.

This video explains the 5 most common symptoms of injury. In addition, Dr. Bastian’s prior video on vocal cord swelling checks can help the singer know when to begin thinking “my problem may be injury, and not acid reflux or a technical deficit.”

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