The movement of the vocal folds during speech The vocal cords consist of five layers of cells: * Squamous epithelium * Superficial lamina propria<unk> 's space) * Intermediate lamina propria * Deep lamina propria * Vocalis muscle In order for humans to produce sound for speech, the vocal folds must readily vibrate. The two layers of the vocal cords that vibrate are the<unk> 's space and the overlying epithelium. In fact, these layers move freely over the more rigid intermediate and deep lamina proprias. Accumulation of fluid within the<unk> 's space alters the elasticity of the vocal cord, making it less stiff and more gelatinous. This slows the vocal cord vibration, which results in a deepened and hoarse voice. Because men normally have a lower voice than women, the change is more noticeable in women. Edema usually occurs on both vocal cords. This is known as bilateral<unk> . The pathophysiology or mechanism of<unk>  is not well known, however, chemicals contained within cigarette smoke are associated with an increased vascular permeability of blood vessels, which results in fluid leaking into the<unk> 's space. Normally, the vocal cords are surrounded by neatly aligned blood vessels, however, these blood vessels can become disarranged and fragile in<unk> . In addition, cigarette smoke can create reactive oxygen species that alter the environment of the vocal cords. Tissue analysis of<unk>  shows decreased amounts of the proteins fibronectin, elastin, collagens I and III, and extracellular matrix proteins. This leads to an overall decreased stiffness of the tissue layer, which vibrates more slowly and produces a deeper sounding voice. The progression of<unk>  is gradual and is directly related to the duration of exposure to risk factors, such as smoking and gastric reflux. Disease progression is divided into two types: "pale" and "livid". The “pale” type of<unk>  is defined by a glazed appearance of the vocal cords with a clear (colorless) fluid underneath. This represents the early stage of the disease. The advanced “livid” type of<unk>  is identified by an increased amount of fluid, accompanied by a color change from colorless to yellow-grey. The swelling of the vocal folds cause ballooned-like appearance, known as a polyp. The polyps of<unk>  are usually benign, however, there may be a risk of cancer if the patient is a smoker. Additionally, if the edema becomes too severe, patients may experience difficulty breathing due to blockage of the airway.
Reinke's edema
Berlin's edema
Forchheimer spots
Fuchs spot
Koplik's spots
Bitot's spots
Olney's lesions
Roth's spot