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Anatomy and Physiology of Voice Production | Understanding How Voice is

Produced | Learning About the Voice Mechanism | How Breakdowns Result in Voice
Disorders

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Key Glossary Terms

Larynx
Highly specialized structure atop the windpipe responsible for sound production, air
passage during breathing and protecting the airway during swallowing

Vocal Folds (also called Vocal Cords)

“Fold-like” soft tissue that is the main vibratory component of the voice box; comprised
of a cover (epithelium and superficial lamina propria), vocal ligament (intermediate and
deep laminae propria), and body (thyroarytenoid muscle)

Glottis (also called Rima Glottides)

Opening between the two vocal folds; the glottis opens during breathing and closes
during swallowing and sound production

Glossary
Understanding Voice DisordersKnowing how normal voice is produced and the roles the
voice box and its parts play in speaking and singing helps patients understand their voice
disorders

Voice “As We Know It”

The “spoken word” results from three components of voice production: voiced sound,
resonance, and articulation.
  Voiced sound: The basic sound produced by vocal fold vibration is called “voiced
sound.” This is frequently described as a “buzzy” sound. Voiced sound for singing
differs significantly from voiced sound for speech.
 Resonance: Voice sound is amplified and modified by the vocal tract resonators
(the throat, mouth cavity, and nasal passages). The resonators produce a person’s
recognizable voice.
 Articulation: The vocal tract articulators (the tongue, soft palate, and lips) modify
the voiced sound. The articulators produce recognizable words.

Voice Mechanism
Speaking and singing involve a voice mechanism that is composed of three subsystems.
Each subsystem is composed of different parts of the body and has specific roles in voice
production.

Three Voice Subsystems

Subsystem Voice Organs Role in Sound Production

Air pressure Diaphragm, chest Provides and regulates air pressure to

system muscles, ribs, cause vocal folds to vibrate

abdominal

musclesLungs

Vibratory Voice box (larynx)Vocal Vocal folds vibrate, changing air pressure

system folds to sound waves producing “voiced sound,”

frequently described as a “buzzy

sound”Varies pitch of sound

Resonating Vocal tract: throat Changes the “buzzy sound” into a person’s

system (pharynx), oral cavity, recognizable voice

nasal passages

Key Function of the Voice Box

The key function of the voice box is to open and close the glottis (the space between the
two vocal folds).

 Role in breathing: Open glottis

  Role in cough reflex: Close, then open glottis
 Role in swallowing: Close glottis
 Role in voice: Close glottis and adjust vocal fold tension (plus additional functions
for singing)

Key Components of the Voice Box

Cartilages

 Muscles
 Nerves
 Vocal folds

Abnormalities or Changes in the Vibratory System Result in Voice Disorders

Breakdowns can occur in any one or all three subsystems of voice production. This
patient education series focuses on voice disorders, specifically breakdowns in the
vibratory system.

Key Glossary Terms

Larynx
Highly specialized structure atop the windpipe responsible for sound production, air
passage during breathing and protecting the airway during swallowing

Vocal Folds (also called Vocal Cords)

“Fold-like” soft tissue that is the main vibratory component of the voice box; comprised
of a cover (epithelium and superficial lamina propria), vocal ligament (intermediate and
deep laminae propria), and body (thyroarytenoid muscle)

Glottis (also called Rima Glottides)

Opening between the two vocal folds; the glottis opens during breathing and closes
during swallowing and sound production

Glossary

Voice as We Know It = Voiced Sound + Resonance + Articulation

The “spoken word” results from three components of voice production: voiced sound,
resonance, and articulation.

Voiced sound: The basic sound produced by vocal fold vibration is called “voiced sound.”
This is frequently described as a “buzzy” sound. Voiced sound for singing differs
significantly from voiced sound for speech.

Resonance: Voiced sound is amplified and modified by the vocal tract resonators (the
throat, mouth cavity, and nasal passages). The resonators produce a person’s
recognizable voice.

Articulation: The vocal tract articulators (the tongue, soft palate, and lips) modify the
voiced sound. The articulators produce recognizable words.

Voice Depends on Vocal Fold Vibration and Resonance

Sound is produced when aerodynamic phenomena cause vocal folds to vibrate rapidly in
a sequence of vibratory cycles with a speed of about:

 110 cycles per second or Hz (men) = lower pitch

 180 to 220 cycles per second (women) = medium pitch
 300 cycles per second (children) = higher pitchhigher voice: increase in frequency
of vocal fold vibrationlouder voice: increase in amplitude of vocal fold vibration

Vibratory Cycle = Open + Close Phase

The vocal fold vibratory cycle has phases that include an orderly sequence of opening
and closing the top and bottom of the vocal folds, letting short puffs of air through at
high speed. Air pressure is converted into sound waves.

Not Like a Guitar String

Vocal folds vibrate when excited by aerodynamic phenomena; they are not plucked like a
guitar string. Air pressure from the lungs controls the open phase. The passing air
column creates a trailing “Bernoulli effect,” which controls the close phase.

The Process of Voice

Voice production involves a three-step process.

1. A column of air pressure is moved towards the vocal folds

2. Air is moved out of the lungs and towards the vocal folds by coordinated
action of the diaphragm, abdominal muscles, chest muscles, and rib cage
3. Vocal fold vibration – sequence of vibratory cycles:
 Vocal folds are moved to midline by voice box muscles, nerves, and cartilages
 The vibratory cycle occurs repeatedly; one vibratory cycle is as follows:
1. Column of air pressure opens bottom of vocal folds
2. Column of air continues to move upwards, now towards the top of vocal
folds, and opens the top
3. The low pressure created behind the fast-moving air column produces a
“Bernoulli effect” which causes the bottom to close, followed by the top
4. Closure of the vocal folds cuts off the air column and releases a pulse of
air
5. New cycle repeats
 The rapid pulses of air created by repeat vibratory cycles produce “voiced
sound” which is really just a buzzy sound, which is then amplified and
modified by the vocal tract resonators, producing voice “as we know it.” (See
table below)
 Loudness: Increase in air flow “blows” vocal folds wider apart, which stay
apart longer during a vibratory cycle – thus increasing amplitude of the
sound pressure wave
 Pitch: Increase in frequency of vocal fold vibration raises pitch

Diagram of Vocal Fold Vibration

 1 Column of air pressure moves upward towards vocal folds in
“closed” position
2, 3 Column of air pressure opens bottom of vibrating layers of vocal folds; body of
vocal folds stays in place
4, 5 Column of air pressure continues to move upward, now towards the top of vocal
folds, and opens the top New vibratory cycle
6–10 The low pressure created behind the fast-moving air column produces a Bernoulli
effect which causes the bottom to close, followed by the top
10 Closure of the vocal folds cuts off the air column and releases a pulse of air
(click for larger image)
– repeat 1-10 In the closed position (—) maintained by muscle, opens and closes in a
cyclical, ordered and even manner (1 – 10) as a column of air pressure from the lungs
below flows through. This very rapid ordered closing and opening produced by the
column of air is referred to as the mucosal wave. The lower edge opens first (2-3)
followed by the upper edge thus letting air flow through (4-6). The air column that flows
through creates a “Bernouli effect” which causes the lower edge to close (7-9) as it
escapes upwards. The escaping “puffs of air” (10) are converted to sound which is then
transformed into voice by vocal tract resonators. Any change that affects this
mucosal wave – stiffness of vocal fold layers, weakness or failure of closure,
imbalance between R and L vocal folds from a lesion on one vocal fold – causes
voice problems. (For more information, see Anatomy: How Breakdowns Result in Voice
Disorders.)

3. Vocal tract – resonators and articulators: The nose, pharynx, and mouth
amplify and modify sound, allowing it to take on the distinctive qualities of voiceThe
way that voice is produced is analogous to the way that sound is produced by a
trombone. The trombone player produces sound at the mouthpiece of the
instrument with his lips vibrating from air that passes from the mouth. The
vibration within the mouthpiece produces sound, which is then altered or “shaped”
as it passes throughout the instrument. As the slide of the trombone is changed,
the sound of the musical instrument is similarly changed.

Amazing Outcomes of Human Voice

The human voice can be modified in many ways. Consider the spectrum of sounds –
whispering, speaking, orating, shouting – as well as the different sounds that are
possible in different forms of vocal music, such as rock singing, gospel singing, and
opera singing.

Key Factors for Normal Vocal Fold Vibration

To vibrate efficiently vocal folds need to be:

At the midline or “closed”: Failure to move vocal folds to the midline, or any lesion which
prevents the vocal fold edges from meeting, allows air to escape and results in breathy
[Link] players: muscles, cartilages, nerves

Pliable: The natural “built-in” elasticity of vocal folds makes them pliable. The top, edge,
and bottom of the vocal folds that meet in the midline and vibrate need to be pliable.
Changes in vocal fold pliability, even if limited to just one region or “spot,” can cause
voice disorders, as seen in vocal fold [Link] players: epithelium, superficial lamina
propria

“Just right” tension: Inability to adjust tension during singing can cause a failure to reach
high notes or breaks in [Link] players: muscle, nerve, cartilages

“Just right” mass: Changes in the soft tissue bulk of the vocal folds – such as decrease
or thinning as in scarring or increase or swelling, as in Reinke’s edema, produce many
voice symptoms – hoarseness, altered voice pitch, effortful phonation, etc. (For more
information, see Vocal Fold Scarring and Reinke’s Edema.)Key players: muscles, nerves,
epithelium, superficial lamina propria

Learning About the Voice Mechanism

Speaking and singing involve a voice mechanism that is composed of three subsystems.
Each subsystem is composed of different parts of the body and has specific roles in voice
production.

Three Voice Subsystems

Subsystem Voice Organs Role in Sound Production

Air pressure Diaphragm, chest Provides and regulates air pressure to

system muscles, ribs, cause vocal folds to vibrate

abdominal

musclesLungs

Vibratory Voice box (larynx)Vocal Vocal folds vibrate, changing air pressure

system folds to sound waves producing “voiced sound,”

frequently described as a “buzzy

sound”Varies pitch of sound

Resonating Vocal tract: throat Changes the “buzzy sound” into a person’s

system (pharynx), oral cavity, recognizable voice

nasal cavities

Diagram of Voice Subsystems

(click for larger image)

Air Pressure System

The ability to produce voice starts with airflow from the lungs, which is coordinated by
the action of the diaphragm and abdominal and chest muscles.

Vibratory System

 The voice box (larynx) and vocal folds (sometimes called vocal cords) comprise the
vibratory system of the voice mechanism.
 Resonating System
 The vocal tract is comprised of resonators which give a personal quality to the
voice, and the modifiers or articulators which form sound into voiced sounds.

Key Function of the Voice Box

The key function of the voice box is to open and close the glottis (the space between the
two vocal folds).

 Role in breathing: open glottis

 Voice box brings both vocal folds apart during breathing.
 Role in cough reflex: close, then open glottis
 Voice box closes the glottis to build up pressure, then opens it for the forceful
expelling of air during cough.
 Role in swallowing: close glottis
 Voice box coordinates closing the glottis by bringing both vocal folds to the
midline to prevent choking during swallowing.
 Role in voice: close glottis and adjust vocal fold tension
 Voice box brings both vocal folds to the midline to allow vocal fold vibration
during speaking and singing.
 Voice box adjusts vocal fold tension to vary pitch (how high or low the voice
is) and changes in volume (such as loud voice production).

Key Components of the Voice Box

 Cartilages
  Muscles
 Nerves
 Vocal Folds

Voice Box Cartilages

There are three cartilages within the larynx.

 Thyroid Cartilage

1. Forms the front portion of the larynx

2. Most forward part comprises the “Adam’s apple”
3. Houses the vocal folds
4. Vocal folds attach just below the Adam’s apple

 Cricoid Cartilage

1. Below the thyroid cartilage

2. Ring-like: front to back
3. Becomes taller in the back of the voice box
4. Platform for the arytenoid cartilages

 Arytenoid Cartilages (left and right)

1. Pair of small pyramid-shaped cartilages

2. Connect with the cricoid cartilage at the back of the vocal folds
3. With the cricoid cartilage, forms the cricoarytenoid joint

Voice Box Muscles

Voice box muscles are named according to the cartilages to which they are attached.

Voice Box Muscles – Cartilage Attachments, Role, Nerve Input

Muscles, Cartilage Attachments, and their Main Roles Nerve Input

Muscles That Position Vocal Folds in the Midline During Sound Production (close

glottis)

 Thyroarytenoid muscle Recurrent laryngeal

 R & L muscles; attached to thyroid and arytenoid nerve (RLN)

cartilages on each side

 Action shortens and relaxes vocal ligament

  Note: deeper inner fibers referred to as “vocalis muscle”

(see below)

 Lateral cricoarytenoid muscle (R & L muscles)

 Attached to cricoid and arytenoid cartilage on each side

 Closes or adducts vocal folds

 Inter-arytenoid muscle (transverse and oblique)

 Attached between right and left arytenoid cartilages

 Closes inlet of larynx

These muscles work coordinately to position both vocal folds in the

midline for vocal fold vibration during sound production.

 Role in voice production

 Role in protection of airway during swallowing

Muscle That Moves Vocal Folds Apart (open glottis)

 Posterior cricoarytenoid muscle Recurrent laryngeal

 Attached to cricoid and arytenoid cartilages nerve (RLN)

 o Move arytenoid cartilages so as to move both vocal folds

apart, “open” of abduct vocal folds

 Role in breathing

Muscles That Adjust Length and Tension of Vocal Folds

Vocalis muscle (derived from inner and deeper fibers of Recurrent laryngeal

thyroarytenoid msucle] nerve (RLN)

 Alters vocal fold tension/relaxation during speaking or singing

  Role in voice production

Cricothyroid muscle Superior laryngeal

nerve (SLN)
 Attached to cricoid and thyroid cartilages

 Tilts the thyroid cartilage, thus increasing tension of vocal folds

 Role in high-pitch singing

 Role in pitch glide in singing

Diagram of Voice Box Cartilages and Muscles

Voice box muscles are named according to the cartilages to which they are attached.

(click for larger image)

Nerve Input to the Voice Box

The brain coordinates voice production through specific nerve connections and signals

Signals to the voice box for moving voice box muscles (motor nerves) come from:

 Signals from the voice box structures for feeling (sensory nerves) travel through
sensory branches of the RLN and SLN
 Motor branches of recurrent laryngeal nerve (RLN)
 Superior laryngeal nerve (SLN)

Key Information

“Recurrent” laryngeal nerve: The recurrent laryngeal nerve is so named because on

the left side of the body it travels down into the chest and comes back (recurs) up into
the neck to end at the larynx. [see figure below] Long path of left RLN: The circuitous
path of the left RLN throughout the chest is one reason why any type of open-chest
surgery places patients at risk for a recurrent laryngeal nerve injury, which would result
in vocal fold paresis or paralysis. [see figure below] (For more information, see Vocal
Fold Scarring and Vocal Fold Paresis / Paralysis.) Shorter path of right RLN: The right
recurrent laryngeal nerve continues in the upper chest and loops around the right
subclavian artery, just behind the clavicle (collarbone), then travels the short distance in
the neck to the larynx.

Diagram of Key Nerves for Voice Production

This diagram shows the “long path” of the left recurrent laryngeal nerve

(left RLN). After it branches off the vagus nerve, the left RLN loops around

the aortic arch in the chest cavity and then courses back into the [Link]
 long course makes it at higher risk for injury compared with the shorter

course of the right RLN which does not run through the chest cavity.(click

for larger image)

Vocal Folds

The left and right vocal folds are housed within the larynx. The vocal folds include three distinct layers that work
together to promote vocal fold vibration.

1. Covering/mucosa: Loose structure that is key to vocal fold vibration during sound production; is composed of:
 Epithelium
 Basement membrane
 Superficial lamina propria (SLP)
2. Vocal ligament: The vocal ligament is composed of:Body: The vocal fold body is composed of the
thyroarytenoid muscle. This muscle helps close the glottis and regulate tension of vocal fold during speaking
and/or singing. The medial portion of this muscle is also called “vocalis muscle.”
 Intermediate lamina propria
 Deep lamina propria (contains collagen fibers that are stronger and more rigid than the superficial lamina
propria)
3.

Diagram of Vocal Folds

(click for larger image)
“Wiper-Like” Movement of Vocal Folds

The vocal folds move similar to a car’s windshield wipers that are attached to the middle of the windshield and open
outwards. (See figure below.)


The front ends of both vocal folds are anchored to the front-middle (anterior commissure).
 The back ends of both vocal folds are anchored to the arytenoid cartilages.
 When arytenoids are moved to the open position by the posterior cricoarytenoid muscle, vocal folds open,
resulting in glottal opening.
 When arytenoids are closed by the lateral cricoarytenoid and inter arytenoid muscles, vocal folds are brought to
the midline resulting in glottal closure.

Vocal Folds (vf) Opening and Closing

How Breakdowns Result in Voice Disorders

Key Glossary Terms

Larynx
Highly specialized structure atop the windpipe responsible for sound production, air
passage during breathing and protecting the airway during swallowing

Vocal Folds (also called Vocal Cords)

“Fold-like” soft tissue that is the main vibratory component of the voice box; comprised
of a cover (epithelium and superficial lamina propria), vocal ligament (intermediate and
deep laminae propria), and body (thyroarytenoid muscle)

Glottis (also called Rima Glottides)

Opening between the two vocal folds; the glottis opens during breathing and closes
during swallowing and sound production
 Glossary

In Brief

Voice disorders refer to breakdowns in the vibratory system. Breakdowns can affect any
one or all of the three subsystems of voice production.

Air Pressure System

If the airflow source is weak or inefficient (making it difficult to push enough air out of
lungs), the voice will be weak and hampered by shortness of breath.

 For example: Patients with asthma, lung cancer, emphysema and other lung
conditions often find it difficult to speak loud or for long periods of time.

Vibratory System
Any compromise or change to vocal fold vibration causes hoarseness and other voice
symptoms.

 For example: Patients with stiffness in the vocal folds from swelling from a common
cold develop hoarseness.
 For example: When focal folds cannot come perfectly together from partial nerve
input loss, air leak occurs and the voice is “breathy.”

Resonating System or Vocal Tract

A breakdown of the vocal tract can affect voice quality.

 For example: When nasal passageways are swollen and inflamed during the
“common cold,” the voice takes on a nasal quality.

Making Sense of It All

The following are a few examples depicting how breakdowns result in voice disorders and
a few of the many possible voice symptoms.

Correlating Anatomy, Voice Function, Abnormalities, and Possible Voice Disorder

Symptoms

A Glimpse
Sound Examples of
Brief – “who does
Proces “Breakdowns” that Possible Symptoms
Description what” in Sound
s Affect Sound Process
Production

Genera “Breath Diaphragm, Lung diseaseAirway Shortness of

ting Air Support” abdominal and obstruction: asthma, breathWeak voice

Coordinated chest muscles subglottic

Pressur functions of move air into stenosisParesis/paralysi

e diaphragm, and out of s of muscles

abdominal and lungsLungs are

chest muscles, the organs for

lungs and chest airBronchi and

cavity move air trachea are the

column passageway for

upwards air from lungs

through vocal

folds

Glottic Vocal Fold Laryngeal Paresis/paralysis – HoarsenessBreathin

Closur Position muscles RLN/SLNMuscle essEffortful

e Critical contract to weaknessNeurological phonationVocal

Positio Vocal folds are close vocal diseases; muscular fatigueDiplophonia

n of in closed foldsArytenoid disordersArytenoid

vocal position for cartilages pivot arthritisVocal fold

folds speech or to move vocal granulomaVocal fold

singing folds towards nodules, polyps,

[Note: Vocal midline cystsVocal fold

folds are open [“closed”]RLN atrophyVocal fold

for breathing] and SLN bring scarring

nerve inputs to

musclesVocal

fold mass and

edge contribute
 to glottic

closure

Vocal Wavelike Superficial Vocal fold scarVocal fold HoarsenessEffortful

Fold Vibration lamina propria lesions: cysts, nodules, phonationWeak

Vibrati from Bottom is the main polyps, papillomaVocal voiceSpeaking voice

on to Top–repeat vibrating layer fold granulomaSwelling lower than

Produc vibratory in vocal fold and inflammation usual”Vocal

es cyclesWith each mucosaVocal (reflux laryngitis, viral fry”Voice fatigue

Voiced vocal fold fold pliability is laryngitis)Reinke’s

Sound vibratory cycle, critical for edemaParesis/paralysis

a puff of air vibrationVocal Hemorrhage, vascular

escapes, fold surface ectasias

producing voice integrity allows

sound (“buzzy mucosal wave

sound”)Singing propagationVoc

voice produces al fold mass

unique sound and edge

spectra (singing contribute to

formants) that glottic closure

are distinct

from spoken

voice

Voice Amplitude of Breath Vocal fold Unable to project

Volum Sound Waves supportLarynge scarParesis/paralysisVoc voiceWeak

e or Loudness is al muscles al fold lesions: cysts, voiceVoice breaks

Loudne achieved contract to nodules, polyps,

ss by:Increasing adjust tension papillomaVocal fold

air of vocal granulomaSwelling and

pressure/flowIn foldsVocal fold inflammation (reflux

creasing vocal elasticity allows laryngitis, viral

fold resistance folds to “open laryngitis)

wider” and

“stay apart”

longer

Voice Frequency of Laryngeal SLN Unable to hit high

Pitch Sound muscles paresis/paralysisVocal notesLoss of

or WavesIncrease contract to fold scarReinke’s glissandoVoice

Highne d tension for adjust tension edemaVocal fold lesions breaks

ss / high notes of vocal folds–

Lownes (high especially for

s frequency)Decr high notesVocal

eased tension fold

for low notes elasticity/pliabil

(low ityVocal fold

frequency)Grea edge integrity

ter air pressure

and increased

tension for high

notes
Voice Person’s Vocal fold

Quality “Own” Voice elasticity/pliabil

or Vocal ityVocal fold

Timbre tract resonators resistanceVocal

amplify and fold

modify voiced massPerson’s

sound, giving vocal fold

personal quality features: e.g.,

to a person’s stiffness, bulk,

voicee.g., sizeVocal tract

John’s voice not resonators

equal to Jim’s (throat, oral

voice cavity, nasal

cavities)