Sulcus vocalis is a term used for the absence of the superficial lamina propria of the vocal fold. Normal phonation requires independent vibration of the multiple layers of the vocal fold. When a portion of a very important layer is missing, hoarseness may result. No one knows how sulcus vocalis forms. It may occur during normal laryngeal growth or perhaps form after other vocal fold lesions resorb. Once present, the hoarseness that results usually has a harsh quality. The additional effort used in speaking often results in pitch changes as well. The treatment of sulcus vocalis is difficult and evolving. The fundamental problem that we face is there is no way to perfectly replaced missing superficial lamina propria. An ideal substitute is not currently available. Treatment has mainly involved microlaryngeal surgery and includes resecting scar and filling the lamina propria layer with some other filler material. New techniques are always been explored and described. The expertise of your physician treating sulcus vocalis is of critical importance.