Vocal fold scarring occurs after inflammation or trauma/injury of the vocal fold mucosa and is histologically characterized by abundant and disorganized collagen deposition. These histological alterations stiffen the vocal fold mucosa, disturbing regular and symmetrical vibrations, and clinically result in severe and intractable dysphonia. There are no established treatment options for the prevention or restoration of vocal fold scarring, making its resolution one of the remaining challenges in the treatment of voice disorders. Recently, it has been shown that tissue fibrosis can be prevented by controlling macrophage phenotypes in some organs, and macrophages are considered master regulators of tissue fibrosis. Research on the prevention or restoration of fibrosis focusing on macrophage polarization in the vocal fold is gradually progressing. Although this is a nonclinical study, we were able to show that controlling the polarity of macrophages with drugs has a preventive effect on vocal fibrosis. In this article, we review studies on vocal cord scarring, focusing on macrophages.