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Voice and sulcus

  • Writer: Valentina Carlile DO
    Valentina Carlile DO
  • 10 hours ago
  • 2 min read
Voce e sulcus

A sulcus is a lesion characterized by the disappearance of the lamina propria, which is replaced by scar tissue.


Ford describes three types of sulcus:

  • Type I Sulcus: caused by the imprint that the vocal process of the arytenoids produces on the vocal folds when they are apart. Dysphonia may range from variable to normal. It is more evident during deep inspiration and in elderly patients with vocal atrophy. The vocal ligament is normal and Reinke’s space appears intact. Videostroboscopy is usually normal, and the vocal muscle may show possible atrophy.


  • Type II Sulcus or “vergeture”: causes moderate dysphonia, and vocal stiffness is visible on videostroboscopy. Reinke’s space is involved and may be absent, the vocal ligament may be normal or adherent, and the vocal muscle is not altered.


  • Type III Sulcus or open sulcus: can be considered an epidermoid cyst that has opened on the superior surface and emptied its contents, leaving a virtual cavity. The dysphonia it produces is severe, and videostroboscopy shows stiffness and absence of a mucosal wave. Reinke’s space is involved and may be absent, as well as the vocal ligament. The vocal muscle may also be affected. When the sulcus opens on both the upper and lower sides of the vocal fold, it is called a mucosal bridge. This invagination can sink into the vocal fold, reaching the depth of the ligament and damaging its fibers.


Symptoms vary widely and depend on the size of the lesion, its depth, degree of adhesion to the vocal ligament, associated fibrosis, concomitant lesions, and the individual’s vocal technique.

The mildest symptoms are usually a tendency toward vocal fatigue, high pitch, and a dull, muffled vocal quality with few overtones. It is common for patients to complain more about vocal discomfort—such as effort and fatigue when speaking—than about the rough timbre, which they often have already adapted to. Jitter is one of the most altered acoustic parameters due to the strained and aperiodic voice.



Valentina Carlile - Osteopath specializing in Osteopathy for Voice and Speech Disorders since 2002. For information and bookings, visit the Contact page.





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