Vocal fold bowing is a condition that prevents one or both of your vocal folds from closing normally. Unilateral bowing affects only one fold, and bilateral affects both. When your vocal cords cannot close completely, your voice will sound breathy or weak.

Vocal ford atrophy refers to the gradual change in vocal cords as people age.


What Causes Vocal Fold Bowing and Atrophy?

The bowing of your vocal folds occurs when the muscles or nerves that control them become damaged. This can be caused by:

  • A breathy voice.
  • A hoarse voice.
  • A weak voice (difficulty speaking loudly).
  • Throat pain or discomfort.
  • Voice fatigue.

Often, there is no known cause for the bowing. Some researchers believe that vocal fold bowing and atrophy simply occurs naturally with age.

What Are the Symptoms of Vocal Fold Bowing and Atrophy?

Common symptoms of vocal fold bowing and atrophy include:

  • A breathy voice.
  • A hoarse voice.
  • A weak voice (difficulty speaking loudly).
  • Throat pain or discomfort.
  • Voice fatigue.

How is Vocal Fold Bowing and Atrophy Diagnosed and Treated?

In order to diagnose your vocal fold bowing, your ENT physician will perform the following:

  • A medical and voice history report.
  • A physical examination of the head and neck.
  • An endoscopic examination of the vocal folds.

A speech-language pathologist (SLP) may also be called in to complete a voice evaluation.

Once your disorder is diagnosed, your ENT doctor will discuss the treatment options with you.


Surgery to treat vocal fold bowing involves injecting a substance such as fat or synthetic collagen into the vocal folds to decrease their size. You will then be put on voice rest to give your vocal fold tissue time to heal.

There is a possibility that this surgery will need to be repeated, as vocal folds can absorb the injected substances and return to their bowed state over time.

For those with severe bowing, another type of surgery may be needed. This procedure involves placing an implant into the cartilage surrounding the vocal folds. The implant pushes the vocal folds closer to each other to form a tighter seal within the voice box.

Voice Therapy

Voice therapy is a noninvasive approach to vocal fold bowing. You will work with a speech-language pathologist to both strengthen your voice and reduce the symptoms associated with vocal fold bowing.

Therapy typically lasts for several weeks and involves both in-office and at-home activities designed to help you improve your voice. You will receive counseling on lifestyle changes that may help you strengthen your voice.


Asthma, allergies and extraesophageal reflux can contribute to the symptoms brought on by vocal fold bowing. Medication designed to treat these disorders has been shown to also help treat the symptoms of vocal fold bowing.

Your ENT physician may option for a combined modality approach. This involves a combination of therapy, surgery and medications.

Call Topeka ENT at 785-233-0500 for more information or to schedule an appointment.

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