Vocal Cord Haemorrhage

Haemorrhage (bleeding) into a vocal cord is a medical emergency for the professional singer. Failure to diagnose the condition may lead to further tissue damage and scarring, resulting in a permanent husky quality and loss of vocal range. In fact just recently, worldwide singing sensation Adele was diagnosed with Vocal Cord Haemorrhage and forced to cancel a sell-out US tour. The heartbroken singer was told she must rest to avoid damaging her voice forever.

In an interview with Boots Web MD, our Harley Street ENT specialist Dr Gerald Brookes, who works with singers and is the first stop for ailing X Factor stars, agreed with this advice, saying: ‘You have to tell the performer they cannot perform, they cannot sing. They have to stop there and then.’

Voice is produced through vocal cord vibration. Bleeding into the surface tissues of the vocal cord causes swelling which prevents normal vibration movements. This manifests as hoarseness and a sudden inability to sing properly – sometimes the voice is even lost completely. It can occur after strenuous or prolonged singing (Figure 1) or the vocal abuse of screaming or shouting, when a small blood blister may form (Figure 2). Sometimes the haemorrhage involves the whole vocal cord (Figure 4). Tiny fragile blood vessels of the vocal cord rupture from the physical trauma of forceful closure. Laryngitis or inflammation of the vocal cords expands the minute local blood vessels, and is a common predisposing factor. Sometimes there is a weak blood vessel or varix, which can lead to repeated episodes (Figures 3 & 4). There is no local pain and diagnosis can only be made by direct inspection of the larynx (voice box) by an experienced Ear, Nose & Throat Surgeon.

Figure 1: Acute left vocal cord haemorrhage one day after an intense singing schedule. There are dilated blood vessels of the vocal cords and adjacent tissues due to acid reflux.

Figure 2: Acute right vocal cord haemorrhage 3 days after screaming. The swelling is on the edge of the vocal cord preventing full closure. There are also dilated blood vessels of the adjacent soft tissues due to acid reflux.

Figure 3: Recent haemorrhage from a weak dilated blood vessel (varix) of right vocal cord. There is thickening of both vocal cords from prolonged over usage of the voice and dilatation of numerous blood vessels of the vocal cords and adjacent tissues due to acid reflux laryngitis.

Figure 4: Acute haemorrhage involving left vocal cord completely. The arrow shows a small weak dilated blood vessel.

Treatment is by immediate voice rest for 1 week. If there is an underlying upper respiratory tract infection, swelling or inflammation due to acid reflux, it may also be necessary to proceed with medical treatment with antibiotics, anti-inflammatory drugs or acid reflux medication. The prognosis is usually excellent with full recovery, though careful monitoring is essential to ensure complete resolution (Figure 5). Premature return to a normal singing schedule when there is persistent bruising of the tissues risks further damage and long-term or even permanent voice problems.

Figure 5: The same patient as Figure 3 one week later after voice rest and medical treatment showing complete resolution of the haemorrhage. A small prominent blood vessel persists.

If you think you may be experiencing Vocal Cord Haemorrhage please contact us at The Harley Street ENT Clinic. Our specialists are among the most respected in the country and can diagnose the problem quickly, allowing you to simply concentrate on getting better.