Vocal fold insufficiency

Understanding vocal fold insufficiency

When vocal cords cannot close completely, it is called vocal cord dysfunction, glottic insufficiency, or vocal fold insufficiency. Vocal fold insufficiency may be overlooked in a preliminary clinical evaluation1 in a patient with early or subtle vocal fold weakness where both vocal folds may appear mobile.

Vocal fold insufficiency is a common contributing factor in patients who present with dysphonia.1 A thorough exam, including visualization of the larynx, is essential to diagnose dysphonia caused by vocal fold insufficiency, especially in early stages.

Normal vocal fold closure.

Vocal fold bowing causes an incomplete closure.

Specific types of vocal fold insufficiency include1,2:

  • Paralysis of one or both* vocal folds due to:
    • Nerve injury
      • Iatrogenic—injury from intubation during surgery or surgical procedures themselves, such as thyroidectomy or cervical disc surgery
      • Trauma
    • Disease such as:
      • Tumors
      • Neurologic disorders such as Parkinson’s disease—in fact, more than 70% of patients with Parkinson’s disease experience dysphonia characterized by weak and breathy phonation and dysarthria3
  • Paresis (partial paralysis) of one or both* vocal folds
  • Vocal fold atrophy due to age, disease, or medications

*PROLARN GEL and PROLARYN PLUS are not indicated for paralysis of both vocal folds.

Normal vocal fold closure.

Vocal fold bowing causes an incomplete closure.

A closer look at vocal fold insufficiency as a cause of dysphonia

Dysphonia is difficulty in phonation. It is often referred to as hoarseness. The characteristics of dysphonia include altered vocal quality, pitch, loudness, or effort needed to speak. Dysphonia makes communication difficult, which may reduce quality of life for many patients.4

Not an actual patient.

Vocal fold insufficiency (glottic insufficiency) is a frequent underlying cause of dysphonia.1 Vocal fold insufficiency is often overlooked as a cause, however, and this underrecognition may prevent some patients from getting appropriate treatment for their vocal fold insufficiency. In addition, some older adults simply consider dysphonia a natural part of aging and, therefore, may not seek medical advice.4

Not an actual patient.

Characteristics of dysphonia

A patient with dysphonia, commonly caused by vocal fold insufficiency, can present with a range of vocal issues from mild (simple vocal fatigue, especially at end of the day) to severe (almost complete aphonia, or no voice).1

Not an actual patient.

Other complaints of patients with vocal fold insufficiency may include:





Which patients are candidates for

Not an actual patient.


  1. Rosen CA, Simpson CB. Glottic insufficiency: Vocal fold paralysis, paresis, and atrophy. In: Operative Techniques in Laryngology. Heidelberg, Germany: Springer-Verlag; 2008.
  2. Giraldez-Rodriguez LA, Johns M. Glottal insufficiency with aspiration risk in dysphagia. Otolaryngol Clin North Am. 2013;46(6):1113-1121.
  3. Berke GS, Gerratt B, Kreiman J, Jackson K. Treatment of Parkinson hypophonia with percutaneous collagen augmentation. Laryngoscope. 1999;109(8):1295-1299.
  4. Schwartz SR, Cohen SM, Dailey SH, et al. Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg. 2009;141(3 suppl 2):S1-S31.