speculative laryngeal pathologies

hello friends!

i’m currently in between projects (and exams lol) and y’all seemed to enjoy my last weirdly niche slp infodump newsletter(?) so i thought i’d do one speculating on possible vocal cord pathologies in alix e. harrow’s the everlasting, which i have hyperfixated on for four months straight (basically catnip for my brain: dweeb historian [/affectionate] is extremely down bad for soon-to-be legendary knight who's having an existential crisis + they are both stuck in a time loop for imperialism reasons; alternating second-person pov, minor feelings, gender feelings, 110% yearning, drop-dead gorgeous prose).

(also can i offer you a playlist in this trying time¹ )

there is no writing analogy at the end of this one. 100% fun larynx facts (no photos, but there are diagrams and also slight spoilers;² proceed at your own risk). hopefully some of this is helpful as reference if you’re planning your own fictional laryngeal shenanigans. otherwise: free sleeping aid! (< i am lowkey in a one-sided competition with shane hollander to be the most boring person in north america, so. win-win.)

disclaimer i am not a certified medical professional!! please do not take any of this as medical advice. and/or hold your questions until ~2029 🙏🏼

anyway:

case history (harrow, 2025)

• 30M, laryngeal trauma from bayonet; previously diagnosed vocal cord scarring

• voice quality described as thin, hoarse, high-pitched (p. 10), breathy (p. 37)

• possible greater severity in moments of acute stress (pp. 37, 96)

• no reported difficulties modulating pitch within higher range

• no reported swallowing difficulties

• vocal hygiene: smoking, high voice usage occupation (teaching)

• other medical: anxiety, ptsd, intermittent hallucinations

• recent stressors: up for tenure; claims to be stuck in a time loop and forced to lead the love of his life to her death to secure the future of dominion

angles
ok so first of all, i feel like the bayonet would have had to cut at a very specific angle. i.e., it probably missed this thing:

because you would likely bleed out real fast if it hadn’t. it also probably missed this:

which is the main muscle for modulating pitch/intonation (i.e., the general ups and downs in pitch when you’re talking) and that doesn’t seem to have been affected per self and partner report (though: more on general high pitch later).

also, the vocal folds are almost horizontal:

so to get cut there and not the trachea time after time is !! extremely specific!! perhaps planned, even?

anyway. here are some ways said trauma may have contributed to the symptoms described above:

vocal fold scarring (previous dx)
as a bit of background, basically how voicing works is:

1. you breathe in (at which point your vocal folds are apart in a lil v shape \ \ / / ; the narrow end of the v is toward your nose)

2. the vocal cords come together so they’re more parallel, like: | | |

3. when you breathe out, the rush of air out of your lungs starts the vocal cords vibrating against each other, which creates sound. sort of like you’re clapping really really fast. if the vocal cords aren’t doing this in the ideal position or with the right amount of contact (e.g., with scarring—or also other lesions like nodules, a la pitch perfect), there will be changes in sound quality, like if you try to clap with just the tips of your fingers or the heels of your palms. extra air might get through (breathiness) or the vibration may become more turbulent (hoarseness).

   actually, maybe a better analogy: if you’re playing violin with a bow, the sound comes from the vibration between the string and the horse(👈🏼👈🏼😎)hair from the bow. if there’s extra mass for some reason on either, it’s going to interfere with how they come together because they won’t fully be in contact; if either is too loose/floppy, that will add extra “noise” (hoarseness) to the sound.

laryngeal web
this is when the front edges of the vocal folds (at the “point” of the \ \/ /) fuse together. it’s more often a congenital condition, but could happen after surgery as well (i.e., during the healing process), and can lead to hoarseness and higher overall pitch. re: our violin analogy: reducing the effective length of the string by pressing down on the fingerboard gives you a higher note than if you play the open string.

vocal fold paralysis
most of the vocal cord muscles are controlled by these guys:

which could have been damaged in the initial trauma or during surgery afterward. one potential consequence of this is weakness or paralysis of one or both of the vocal folds, which might be stuck in the following positions:

• both apart \ \ / /

  • this is associated with total lack of voice (re: our analogies, the hands cannot clap / air bowing on the violin), so it’s probably not the case here.

• both together in the middle: | | |

  • this closes the airway entirely, which makes it hard to breathe at all and requires immediate medical intervention, so also probably not applicable here.

• one vocal cord is lateral \ \ (the “apart” position), while the other one can move normally

  • may cause breathiness, depending on how far away the paralyzed vocal fold is stuck from center. may also cause issues swallowing liquids (in the violin analogy: the bow is tilted at a weird angle so it’s not fully making contact with the string).

• one is in the middle | | (the “together” position), while the other can move normally

  • if the paralyzed vocal cord has lost muscle tone, this may lead to hoarseness (re: clapping analogy, maybe one hand is “floppier” and causes more turbulence in the sound, as mentioned earlier; re: violin: imagine the string is very loose and rattles a bit) and reduced pitch range.

  • if the paralyzed vocal cord has adequate muscle tone, there may be no effect on voicing.

  • either way, there may be slight airway obstruction that makes it harder to breathe during exertion.

muscle tension dysphonia
this one is interesting because there’s no specific neurological or anatomical reason for symptoms—i.e., no lumps, lesions, etc. on the vocal cords—but the voice may still sound tense/strained, high-pitched, breathy, etc.

in particular, there’s this thing called hyperfunctional underclosure where the vocal cords are so tense that they don’t come together all the way when someone uses their voice, creating additional breathiness/air escape.

there are two different types of mtd. primary mtd may be linked to emotional factors (i.e., stress or, to quote my class slides, “underlying emotional issue related to inability to express thoughts and desires/needs”). secondary mtd comes about when someone is using their throat muscles suboptimally to compensate for a different underlying issue, which can create more symptoms even after the initial problem has resolved. it’s pretty common—about 80% of voice patients have this.

bonus: reinke’s edema
this is primarily caused by chronic irritants such as smoking. the vocal cords swell up, which can also lead to hoarseness (and, in severe cases, airway blockage).

• • •

anyway those are my abridged thoughts lol. thank you for coming to my ted talk and kudos if you’ve gotten this far, i needed to expunge these things from my brain 😆 next time we will go back to regular programming, i promise (< has no idea what’s happening next time)

news:

• i’m so so excited to have a (second-person »: ) ) short story in the ya horror anthology the kids came back wrong ed. wen-yi lee, featuring an absolutely jaw-dropping toc (ana hurtado, andrew joseph white, trang thanh tran, allison saft, mark oshiro, kylie lee baker, aden polydoros, h.e. edgmon, zoe hana mikuta, tigest girma, joelle wellington, wen-yi lee, and yours truly. screech what is my life fr). there are multiple deglovings, if you’re into that kind of thing. most if not all of them are my fault. you can add the book on goodreads!

• i’ll be at readercon (boston-adjacent, july 9–12) and lavendercon (dc, july 25–26) and would love to see you there!

• i think i’ve finally figured out how to turn on comments for this newsletter after 5000 years

recent reading:

• i finally got on board the heated rivalry train lol. mostly the book + tumblr gifs cos im weird about tv. ty also to those who have sent me ao3s 🙏🏼

• reread the everlasting because how did she do that!!!! thereby becoming complicit in the repetition of the time loop. maybe the real time loop was the rereads we did along the way (‘⊙⊙)

• i have elian j. morgan’s princeweaver on preorder—it’s out now in the uk and tues (4/21) in the us & i’m counting down the days!!!. i read the first 10 pages a few years ago and was instantly o b s e s s e d. so ready for prose™ & (more) yearning!!

thanks for reading! please have a vintage rocker boi

1  not technically a swiftie, but also: insert separate essay about how “father figure” is vivian rolfe coded (“you pulled the wrong trigger” dhfhdhfhd). also “turning page” is more about the everlasting than it is about twilight, duel me ✌🏼

2  despite best efforts, i am not entirely sure the redactions formatted correctly :' ) i tried, y’all