Using optical coherence tomography (OCT) to image the larynx during diagnosis and treatment of a vast array of laryngeal disorders continues to develop along with innovative surgical techniques. Precise delineation of vocal fold-layered microstructure allows for better understanding of the impact of benign and malignant lesions on laryngeal function, and optical coherence is uniquely suited to provide detail of the interface between these lesions and adjacent normal tissue. This review provides the reader with a timely update on current clinical and research applications of OCT.Recent advances in OCT include adaptation of these modalities to obtain images of moving vocal folds and provide real-time information during procedures. Additionally, an augmented form of OCT called polarization-sensitive optical coherence tomography (PS-OCT) shows promise in further characterizing benign and malignant lesions and in delineating areas of normal pliability from scar. PS-OCT can quantify areas of increased collagen (scar) and three-dimensional PS-OCT imaging can visualize the extent and location of lesions within vocal folds.Imaging the layered microstructure of vocal folds to precisely delineate boundaries between normal pliability and scar provides valuable information during diagnosis and treatment of benign and malignant disorders. Current OCT imaging techniques are guiding phonomicrosurgical interventions and improving patient care.