Vocal hemorrhage occurs when a blood vessel in the vocal fold or in the vocal cord ruptures, and leaks blood into the superficial lamina propria (SLP). This disrupts the vibrations in the vocal cord and usually causes severe disorder of the voice (dysphonia).
Vocal hemorrhage typically happens as a result of forceful or incorrect use of the voice. Its pathology is the same as a bruise anywhere else on the body, where blood vessels break and leak blood into the skin. The resulting bruise then heals so long as it is not retraumatized. Similarly, in the case of vocal hemorrhage, complete voice rest is essential to allow the vocal cord to remain still. This enables blood to be reabsorbed. Failing to rest the voice can cause further bleeding and scarring.
The most common symptom of vocal hemorrhage is a sudden change in the voice. The voice may become hoarse, reduced in range or may even fail completely.
People are at an increased risk of vocal hemorrhage if they have a large blood vessel in the vocal cord. Such vascular enlargement occurs if the voice is used a lot. For example, professional singers are at an increased risk of vocal hemorrhage, particularly in cases where gruelling performance schedules are followed.
Identifying a large blood vessel in the vocal cord
The only way to establish whether a person has a large blood vessel in the vocal cord is to perform a stroboscopy. A strobe can be used to identify the vessel before it ruptures, so that individuals can take precautionary measures to prevent hemorrhage. If a vocal cord has hemorrhaged, stroboscopy is useful in establishing the prognosis and the stage of healing.
If the symptoms of hemorrhage are ignored, or the condition is incorrectly diagnosed, it may put the person at risk of vocal scarring. Scars on the vocal cord can lead to permanent hoarseness and loss of vocal range.
Diagnosing a vocal fold hemorrhage is straightforward. The vocal cord is normally ivory-white in colour. When a bleed has occurred, a stroboscopy will show a pool of blood inside the vocal fold that causes it to look yellowish and bruised. It is essential that vocal fold hemorrhage is diagnosed as early as possible because research suggests that repeated hemorrhage can cause ongoing changes in vibratory parameters and lead to the formation of vocal polyps.
The only way to treat this problem is through complete voice rest. This does not mean talking less; it means not talking or even whispering at all. Very occasionally, a surgical procedure is required to remove the blood when the amount of pooled blood is excessive. Generally, complete voice rest is all that is needed.
Providing that people ensure they completely and adequately rest their voice immediately after vocal hemorrhage has occurred, the prognosis is generally excellent. In most such cases, the risk of vocal cord scarring or polyp development is very small.
There are several measures people can take to minimize the risk of vocal hemorrhage. These include:
- Taking voice lessons to perfect vocal technique
- Ensuring good fluid intake in order to stay well-hydrated
- Having regular check-ups of the vocal cord to identify any blood vessels that may pose a risk, especially in professions which depend upon the use of the voice
- Avoid straining the voice
- Avoid the use of topical or inhaled steroids which may predispose to vocal cord infection
- Maintaining a clean voice environment by avoiding smoking and ensuring the place where one will perform is clean
Reviewed by Dr Liji Thomas, MD.