Irritation from reflux of stomach fluids into the voice box causes: redness and swelling (indicated with white arrows) in vocal folds (vf) and false vocal folds (f vf) as well as pachyderma (indicated with yellow arrow) or thickening of tissue in between the focal folds.

Note: This patient also has a granuloma (gr), which can also be caused by laryngopharyngeal reflux. (For more information, see Vocal Fold Granuloma.)

In contrast, a normal voice box does not exhibit redness or swelling or any thickening of the surface cover.