Q. What does it mean to have an abnormally sized vocal cord and a scratchy voice?

Answered by
Dr. Shyam Kalyan. N
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 11, 2022

Hello doctor,

I recently had surgery for appendicitis. During the surgery, one of the doctors was concerned about the size of my right vocal cord or my scratchy voice. They took a picture during my breathing tube insertion and suggested me consult an ENT specialist. I was traveling for work for the next few weeks, so looking to get an initial viewpoint as soon as possible. I have attached the picture. Kindly inspect and suggest your diagnosis, doctor.



Welcome to

I read your query and can understand your concern.

I reviewed the picture of your vocal cords (attachments removed to protect the patient's identity). The doctors are right. The right cord is quite bigger and thicker than the left. Additionally, there is a thick inter arytenoid pachydermia.

If I were to elaborate on these two findings, inter arytenoid pachydermia is due to acid reflux. It would help if you had dietary modifications to rid yourself of pachydermia. Such thickening of inter arytenoid region also can cause a change in voice in addition to causing a lump sensation in the throat, frequent throat clearance, and excessive throat mucus.

Next, as for the cords, the size does not mean some issue exists. We need to check the cords' movement with phonation, respiration, and coughing. You must help if you get a flexible video laryngoscopy, an office procedure where they pass a small camera through the nose and visualize the movements of the cords. They also see if the cords approximate completely without any gap between the two during phonation and coughing. If any gap exists, we can see at which level such a gap is present. Phonatory gaps can also be due to reflux and can cause voice change. That would need some speech therapy and vocal hygiene measures to remove.

If one cord is bigger than the other, even in the video laryngoscopy, then if the movements are fine and the approximation is good, we can ignore it. But if they are not, then we will have to investigate further. If either cord movement is sluggish or not moving, we need to see what is the cause for such a slow movement.

We may need to do a CT scan of the skull from the base to the chest. Do revert back to me. Tell me about your dietary habits.

Let me know-

  1. What sort of work you do?
  2. Is there any other throat or nasal symptoms?
  3. Since when have you been facing the voice change issue?
  4. Have you been intubated before the appendicitis operation?

Thank you and take care.

Hello doctor,

Thank you for the reply. I will revert back with more details soon.



Welcome back to

I wanted a few more details.

  1. Do you sing or raise your voice frequently?
  2. Do you play any wind-blowing instruments?
  3. Do you speak a lot at your workplace?
  4. Is there a lot of pollution and particulate matter where you stay or work?

Kindly revert with the answers.

Thank you and take care.

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