Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.

Isabel Casimiro, MD, is board-certified in internal medicine and works as an endocrinologist at the University of Chicago.

Commonly called the voice box, the larynx is located on top of the neck and is essential for breathing, vocalizing, as well as ensuring food doesn’t get stuck in the trachea and cause choking. Sitting just in front of the esophagus, the vocal folds are located here, making this organ absolutely vital for phonation (making speech sounds). It visibly moves up and down when people swallow. This part of the body can be subject to a number of significant medical conditions, including bacterial infection (laryngitis), laryngeal cancer, and vocal fold paralysis (VFP), which can seriously compromise function.

The larynx is a complex band of cartilage, ligament, and muscle as well as a mucous membrane. A hollow structure, it’s formed of three large sections of cartilage that are unpaired—the thyroid, cricoid, and epiglottis—as well as six smaller cartilages. Here’s a quick breakdown of the large cartilages:

Finally, there are a couple free-hanging cartilages, the cuneiform cartilages, located in a membrane called the aryepiglottic membrane, which represents the upper margin of the membrane that connects the arytenoid cartilages to the epiglottic cartilage. This is covered in mucus and forms a structure called the aryepiglottic fold.

It’s also important to look at the interior of the larynx, or laryngeal cavity, which houses important structures, including the vocal cords. This space extends along the opening to the lower portion of the cricoid cartilage; it’s thinner in the middle, and wider in the upper and lower portions. Anatomically speaking, it’s divided into three sections:

Notably, the larynx is associated with two groups of muscles—extrinsic and intrinsic. The former of these move the structure as a whole and move the hyoid, flexing during swallowing and vocalization. In turn, intrinsic muscles are much smaller, and are involved in moving the actual vocal cords during breathing, vocalizing, and swallowing.

The larynx sits at the front of the neck between the third and seventh neck vertebrae (C3 to C7), where it’s suspended in position. The upper portion of this organ is attached to the lower portion of the pharynx, or throat, via the hyoid bone. Its lower border connects to the upper portion of the trachea (also known as the windpipe), which is an important part of the upper respiratory system.

Primarily, differences are seen between male and female larynxes. In men, this feature is more prominent, largely because of a thicker thyroid, and it is angled at 95 degrees, versus 115 degrees in women. As with many parts of the body, there are also a number of other anatomical variations:

As noted above, the larynx primarily is an organ associated with vocalization and making sound. Basically, when you exhale, air is pushed through the glottis, and, it’s the vibrations of the vocal cords that produce noise and sound. During speech or vocalization, the positioning of these vocal cords changes to affect pitch and volume, which can be further modulated by the tongue and relative position of the mouth as necessary for speech.

Additionally, the larynx plays an important role in preventing food from becoming stuck in the airway. When people swallow, the epiglottis shifts downward, blocking off the trachea. The food or liquid then moves to the esophagus, which runs alongside the trachea, and delivers material to the stomach.

A number of conditions can affect this part of the body. These vary from inflammations due to illnesses to cancer. Primarily, these include:

This inflammation of the larynx can be chronic—that is, lasting over three weeks—or acute, with the former being more common. Symptoms of this condition include hoarse voice, pain, couching, and, in some cases, fever. Acute laryngitis is often the result of either viral or bacterial upper respiratory tract infection, with a significant number of cases resulting from fungal growth. Chronic cases tend to be the result of smoking, allergies, or stomach acid reflux. Those who use their voices often, such as singers, teachers, and those in other professions, may experience inflammation of the larynx due to overuse.

Resulting from paralysis of the laryngeal nerve, which innervates the intrinsic laryngeal muscles, vocal fold paralysis (VFP) is the result of a number of conditions, including head or neck injury, stroke, tumors, infections, or other neurological issues. As a result, speech and vocalization function can be severely impacted. This condition sometimes resolves on its own, though speech-language therapy or treatment of underlying causes may be needed to take on this issue.

This form of cancer arises in the glottis, and, like others, can spread aggressively. This leads to hoarseness, changes in voice, the development of lumps in the neck, cough, as well as challenges swallowing. As with other cancers, patients undergo either surgery, chemotherapy, or radiation therapy.

Careful assessment of the larynx is necessary to ensure proper diagnosis of any condition as well as overall function. Here’s a quick breakdown:

Suárez-Quintanilla J, Cabrera A, Sharma S. Anatomy: head and neck, larynx. StatPearls.  

Wilson I, Stevens J, Gnananandan J, Nabeebaccus A, Sandison A, Hunter A. Triticeal cartilage: the forgotten cartilage. Surg Radiol Anat. 2017;39(10):1135-1141. doi:10.1007/s00276-017-1841-z

Winzek C, Hartrampf L, Kampschulte M et al. Unilateral and bilateral agenesis of the upper thyroid horns — A morphometric analysis of the larynx. Forensic Sci Int; 301:225-230.

Informed Health. How does the larynx work?

Cornell Medicine, Sean Parker Institute for the Voice. How are the vocal folds and larynx examined?.

By Mark Gurarie Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.  

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