A vocal fold hemorrhage occurs when there is bleeding involving the superficial lamina propria. This is a thin layer of tissue composed of loosely arranged fibers that provide the vocal folds with the pliability that they need to vibrate during speech. It only takes a small amount of blood to interfere with the ability of the vocal folds to vibrate, so this type of hemorrhage is generally not life threatening.
What Causes a Vocal Fold Hemorrhage?
Vocal fold hemorrhages are typically the result of trauma to the vocal folds. The physical stress of sustained or loud talking can cause small blood vessels in the vocal fold to rupture. It is not unusual for vocal fold hemorrhages to occur after a strenuous musical performance or cheering at a sporting event. Conditions, such as laryngitis, can make the blood vessels more susceptible to rupturing. Individuals with polyps or weak areas within the walls of the blood vessels may also experience vocal fold hemorrhages.
A vocal fold hemorrhage is normally painless and does not interfere with breathing or swallowing. The most obvious symptom is hoarseness that usually develops quickly. In some cases, the symptoms of the hemorrhage are subtle and may only affect the singing voice.
Who is at Risk of a Vocal Fold Hemorrhage?
Vocal fold hemorrhages are most common among professional voice users, including teachers and singers. Individuals who take aspirin, clopidogrel, warfarin, or other blood thinners may also be at increased risk of vocal fold hemorrhages.
Diagnosing Vocal Fold Hemorrhages
Since the blood is trapped under the mucosa of the vocal folds, it spreads throughout the superficial lamina propria. As a result, a part or all of the affected vocal fold turns red. Similar to a bruise, the tissue changes color from dark red to brown before eventually resolving. The by-products of resorption from repeated bleeds may give the vocal folds a yellow hue. In some instances, a dilated blood vessel or polyp may be visible and indicate the potential source of the bleed.
How Are Vocal Fold Hemorrhages Treated?
A single, isolated hemorrhage affecting the entire vocal fold is treated with voice rest to allow the blood time to reabsorb. This involves limiting or avoiding speaking altogether for several days. The patient should undergo repeat examinations to determine when they can resume normal voice use. Continuing to use the voice or using steroids to mask the effects of the hemorrhage may cause further injury, including scarring and permanent voice change.
Individuals who experience recurrent vocal fold hemorrhages should have their vocal folds carefully examined to isolate the underlying cause. Voice therapy may be beneficial if the hemorrhages are the result of harmful vocal habits that put an excessive amount of stress on the vocal folds. A surgery known as a microlaryngoscopy may be necessary if the bleeding is caused by an irregularity in the vocal fold or the blood vessels.