International Foundation for Performing Arts Medicine  

Performance Pulse

                                                                          Vocal Fold Hemorrhage
If there is one word that strikes terror in the heart of even the most Helden of tenors (not to mention sopranos), it is "hemorrhage".  The image of a sudden outpouring of blood with unexpected loss of voice is frightening to every vocal performer.

Surprisingly, vocal fold hemorrhage is not uncommon.  But since most cases are never seen by a Laryngologist, the true frequency of this condition is unknown.  In fact, many singers have minor hemorrhages and attribute the problem to hoarseness.  The change in voice is transient, and typically resolves in a few days.

Like all tissues of the body, the vocal folds have their own blood supply.  Tiny blood vessels course under the vibrating mucous membrane of the vocal folds, and larger vessels supply the muscle of the vocal fold.  Despite the high pressure and rapid vibration in the larynx, these vessels normally function without a hitch, usually for the lifetime of the singer.  In some cases, however, the vessels grow more numerous or prominent.  Their walls may thin out and weaken.  Occasionally, a blood vessel may develop near or at the vibrating edge of the fold, a  "high impact" location.  If the vessel ruptures, bleeding occurs.  This is known as vocal fold hemorrhage.

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