Father and daughter singing who are not affected by a vocal fold hemorrhage

While training for a performance, singers are often told to “sing to the second balcony” in order to make sure that their posture and volume are just right. However, in that pursuit some performers may experience a condition known as vocal fold hemorrhage. What is it, and how can it be treated?

What are the vocal folds?

Producing sound is a multi-step process using three systems: the respiratory system, the phonatory system, and the resonance system. The vocal folds are multi-layered structure of muscle and mucosa that serve as the entrance into the airway. During quiet respiration, they are open and air passes silently in and out of the airway. During voice production, air passes through closed vocal folds causing them to vibrate which creates the sounds. That vibration is then modified and shaped by movements of the lips, tongue, and resonance system and becomes the human voice we hear/recognize during speech and singing.

How can the vocal folds hemorrhage?

Although the vocal folds are built to withstand the rigors of speech and singing, they are delicate. As such, they can be susceptible to injury, particularly under conditions of high intensity voice use. Vocal fold hemorrhaging occurs when the small blood vessels on the vocal folds rupture. This can be triggered by trauma to the vocal folds such as loud or prolonged vocalizations (ie yelling, screaming, prolonged intensive singing), swelling from laryngitis, or periods of heavy/prolonged coughing and/or throat clearing. It can also be triggered by intensive voice use or voice trauma while taking medications that have blood thinning properties, such as aspirin, certain heart medications, and medications designed to reduce the risk of blood clotting.

Lori Ellen Sutton, MA, CCC-SLP, a CEENTA voice and swallowing specialist and classically trained signer at our SouthPark location, provided some quick facts about vocal hemorrhaging:

  • Although typically a painless condition, vocal fold hemorrhaging can cause significant hoarseness, temporary complete loss of voice, and loss of range, which can be a bane on opera singers looking to reach the back row.
  • Female singers are more susceptible to vocal fold hemorrhage during their menstrual cycle due to the vocal fold lining being slightly thicker with hormonal changes and somewhat more vascularized.
  • Sopranos are the singers that are most susceptible to vocal fold hemorrhage (and other vocal fold injuries) because the extremely high pitches they sing require the vocal folds to vibrate faster/with higher frequency which increases friction on the vocal folds.

How is vocal fold hemorrhaging treated?

Vocal hemorrhaging is treated by moderate to total voice rest, depending upon the severity of the hemorrhage. This means no talking or singing until the hemorrhage has resolved. Recovery time for a vocal fold hemorrhage may be as little as 7-10 days or a long as few weeks. Regular surveillance of the hemorrhage by a laryngologist or skilled voice therapist is required to determine how the folds are healing and when gentle voice use can safely be resumed. Prolonged or repeated hemorrhaging could indicate something more serious, which may require more intensive medical intervention.

Whether you’re singing to the balcony or listening to Madama Butterfly by your favorite performers, your vocal care is important. Any negative change in voice quality or function that does not resolve on its own in 2-3 weeks should be evaluated by an ENT/laryngologist. If you begin to experience a sore throat, hoarse voice, or difficulty speaking/singing, CEENTA’s team of voice and swallowing specialists like Lori Ellen Sutton can treat a variety of vocal disorders affecting your ability to talk and sing. Schedule an appointment with CEENTA today to bring your voice to new heights.

This blog is for informational purposes only. For specific medical questions, please consult your doctor. New patients can make appointments online with our doctors in North and South Carolina. Current patients can also make appointments through myCEENTAchart with physicians they have already seen.


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