The voice is an interesting thing. At once, the vocal folds are just a passive valve mechanism designed to protect our respiratory tract, and at other times, they are a view to our deepest emotions through speech and song. No other trait so defines humans as our ability to communicate through speech and express our inner thoughts and feelings. And despite the understanding of the physiology of phonation, we still struggle to explain many of the disorders that affect speech and glottic function. We struggle to come up with new ways to facilitate muscle function and to replicate or repair the delicate structure at the margin of the vocal fold. Many organ systems rely on the larynx for functional support and, in turn, several distant organs may affect laryngeal function. Given the valving function that the larynx undertakes due to its unique position within the aerodigestive tract, influenced and controlled by deglutitive forces, it is exposed to repeated trauma from external and internal material. Trying to understand the key events in neural regulation, or development of dysplasia goes to the core of how the larynx functions. Appreciating normal physiology then uncovers pathologic processes and suggests possible treatment targets.