Vocal cord hemorrhages in voice professionals

Abstract

Summary Singers and other professional voice users may present with hemorrhages of vocal cords following vocal trauma. Several such patients were examined by indirect laryngoscopy, videostrobofiberoscopy, and electrolaryngography. Data were collected on a videotape by dynamic vocal exploration. In 14 cases (12 women and 2 men) without prior treatment, anticoagulants, salicylates, or bleeding disorders, 2 bilateral and 12 unilateral hemorrhages were observed. These patients, with subepithelial hematomas and Reinke's space edema, were studied and followed up for 1 year. The patients with bilateral hemorrhage underwent medical treatment for 1 month and voice rest for 2 weeks. After 1 month, the speaking voice was normal, and the singing voice was almost as it was before the hemorrhage. After 2 months, the voice was entirely recovered for short periods of use, with nearly normal vocal folds. However, voice fatigue after 15 min, occurred, and microvarices were still visible. After 3–6 months, the speaking and singing voice was as before the accident. Of the 12 unilateral hemorrhages, three cases were cured after 1 month of medical treatment, and nine required surgery (CO 2 laser under general anesthesia with microendoscopy technique) despite 5 weeks to 6 months of medical treatment. Two patients were operated on at 5 weeks to evacuate the subepithelial hematoma, and seven were operated on at 6 months to treat the aftereffects.