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Vocal Fold Swelling Pt. 1: What It Is and Why You Should Care

Gap In Vocal Education

Educating singers about vocal fold swelling is a topic that is near and dear to my heart. It has become a cornerstone of my work in the voice clinic and therapy practices and one that we spend a lot of time discussing as a part of any treatment plan. It is probably the topic that people respond to most closely when I lecture anywhere. Most singers have what seems like very little knowledge around vocal fold swelling and how to discern when and if they have it. Managing high vocal demands, overuse, and intermittent swelling is a highly likely scenario for a busy singer and the more we talk about it and equip them to monitor and manage, the better chance they have of avoiding chronic problems.

To be very clear - this phenomenon is not genre or style specific. Nor is age, training level or experience level much of a contributing factor.

Interpreting the Signals

Throughout my 20+ years of helping singers overcome vocal fold injury, I’ve learned a lot about how singers interpret the signals their voices and bodies give them. Vocal fold swelling is a complex and difficult phenomenon to understand when we look at it from the bigger picture standpoint. There are a few different reasons for that -

  1. Our voices are a part of our bodies and any number of internal and/or external factors can influence our voices.

Ex. Like illness, allergies, acid reflux, dehydration, and even environmental factors.

  1. Two, we all have good voice days and bad voice days and rarely experience two days that are alike vocally.

  2. Every single person only knows what they know, or what they’ve been taught.

There is a huge gap in educational experience and training around this topic for singers of all levels. Vocal pedagogy programs rarely include content on this phenomenon and yet, we, as voice teachers and educators, have a responsibility to help our students care for their voices in practical ways. To help them know when they need to rest, to give them permission to say no and not push their voice past it’s limits. A better understanding is essential to management of this complex instrument we need and depend on every day. I am passionate about changing this.

Singers need to understand how the day-to-day changes we experience in our voices are almost certainly tied to our:

-Vocal behaviors


-Our schedules,

-our lifestyles.

The choices we make each day have a direct impact on what happens in the consistency and sustainability of our voices.

How does vocal injury happen?

Vocal fold injury or swelling is usually a result of the amount and/or manner of voice use - essentially vocal overuse or misuse, and often a combination of the two. Vibratory trauma can happen when the vocal load or demand is too high on a regular basis and a little padding or swelling forms on the vibrating edge of the vocal folds in response to that trauma.

(From Hirano M. Clinical examination of voice, New York: Springer-Verlag, 1981:5, ).

We need a smooth, straight line on the vibrating edge of the vocal folds and a perfect match at midline for our voices to vibrate normally.

The outer layer of the vocal folds is called the mucosa. So when we vibrate too much, the mucosa responds to the trauma of the vibration whether it’s too much or too loud or too aggressive by creating a protective cushion. This cushion, or swelling, is the voice's way of saying “I’ve reached my limit.” That padding then distorts the shape of the vocal folds and the match at midline when they’re closing or adducting, limiting flexibility during vibration.

Mild vocal fold swelling is what we might see on a visual laryngeal exam (videostroboscopy) in the morning after a very busy day with excessive voice use. We’ve all had this happen where we notice that we are a little hoarse, or our highest singing notes are a little impaired the next day. This may even happen periodically. For example, once a month or once every two months. As long as the singer knows how to detect this and self-monitor, they can rest the voice until it returns to baseline and be more aware of this pattern.

So What IS Vocal Fold Swelling?

As our vocal folds vibrate and collide millions of times a day our vocal fold tissues (mucosa) respond to the trauma by creating a protective cushion. Just like tissues in any part of our body this is a natural and morally neutral occurrence- not just a thing that happens to singers with “poor technique” or that sing non classical styles. However, there are vocal injuries that can occur due to vibratory trauma to the vocal folds. Swelling is going to affect the way your vocal folds vibrate and will likely affect your high notes first. If you’re dealing with low profile swelling on a daily basis it can result in losing your voice more often (especially with illness).

What is True

  • Mucosa (vocal fold tissues) respond to trauma by creating a protective cushion

  • Result of vocal overuse

  • Vibration is not infinite

  • Swelling will vary day to day

  • Swelling happens at the uppermost layer of the vocal fold, the mucosa (to learn more read Lori's blog on Mucosal vs. Muscular fatigue)

What is Not True

  • Vocal injuries happen to singers with bad technique

  • A singer had to be abusing their voice if there is swelling present

  • There’s nothing we can do to prevent or help vocal fold swelling

What’s Next?

This blog is the first part of a five part series on vocal fold swelling.

Sign up for the mailing list to be alerted when more parts of the series come out and for when we announce the dates of a live workshop on swelling.

Can’t wait that long? Go to Lori’s instagram to get more information, infographics and reels!

Vocal Fold Swelling Pt. 1: What Is Is and Why You Should Care

Vocal Fold Swelling Pt. 2: Warning Signs and Risk Factors (Coming Soon)

Vocal Fold Swelling Pt. 3: Healing, Rest, and Recovery (Coming Soon)

Vocal Fold Swelling Pt. 4: Detection (Coming Soon)

Vocal Fold Swelling Pt. 5: Prevention (Coming Soon)

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