WHAT is a Vocal Fold Hemorrhage?

October 26, 2021

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VOCAL FOLD HEMORRHAGE

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It’s rare that I see a vocal fold (VF) HEMORRHAGE in the clinic, and I realized I don’t have my own picture of a hemorrhage to share on a post I wanted to do….UNTIL I was doing a FEES last week and (wouldn’t you know it!), there was a hemorrhage on the patient’s left true vocal fold! I took it as a sign and began writing up the post. :)

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Vocal fold hemorrhage is an acute phonotraumatic injury that occurs when one or more of the blood vessels in the vocal fold breaks open, filling the vocal fold. Think of it as blood that has “leaked into the vocal fold” from an injured blood vessel. The bleeding is into the superficial lamina propria (the layer that promotes pliability of the vocal fold for vibration).

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Phonotrauma is characterized by the physical stresses caused by voicing upon the tiny blood vessels within the multiple layers of the vocal folds. Poor vocal hygiene can also make someone more susceptible to a vocal fold hemorrhage, and baseline videostroboscopy exams are important for revealing the health of the vocal fold tissues and any visible blood vessels that may be at risk of hemorrhaging. Lennon, Murry, & Sulica (2014) looked at forty-seven patients with vocal fold hemorrhage and aimed to determine factors predicting recurrence. Twelve of the 47 patients (26%) exhibited recurrence, with the presence of VARIX demonstrating a significant association with recurrence. A varix is a prominent, dilated, and commonly tortuous vein found on the surface of the vocal fold. Although somewhat “scary”, when diagnosed early, hemorrhages are completely reversible and very treatable. 

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The most common/obvious symptom is dysphonia (hoarseness) that usually develops quickly. Sometimes the symptoms are subtle and may be most obvious in the singing/performance voice (reduced range). On videostroboscopy, the vocal fold may exhibit reduced vibratory parameters or appear stiff. Causative “trauma” might be extensive voice use when sick (laryngitis can make the blood vessels more prone to rupturing), “pushing” the voice, extensive yelling/cheering or hard coughing, sustained loud talking, and/or a strenuous performance.

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Treatment for vocal fold hemorrhage usually involves voice rest (adequate for a single, isolated hemorrhage), voice therapy (useful for behavioral management and modifying vocal habits that put an excessive amount of stress on the vocal folds), and/or surgical intervention. Recurrence always has an underlying cause and is a generally accepted indication for surgical intervention (to remove or repair any small irregularities or blood vessels that may be the “culrpits”).

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