Vocal Fold Hemorrhages

There are few situations when it is necessary for a vocalist to urgently seek care of a laryngologist (aka throat doctor), but sudden loss of the voice after or during a strenuous performance – without a concurrent upper respiratory infection – is one of them. If this occurs, it is essential to make sure that there has not been a vocal fold hemorrhage.

Vocal fold hemorrhages occur when a small vessel in the vocal cord ruptures and bleeds into the cord. This condition is considered a vocal emergency and is one of the few situations that require absolute voice rest as well as some other forms of medical care. If the voice continues to be used without proper care and treatment, the concern is that a hemorrhagic polyp can develop which then becomes a surgical condition. (A hemorrhagic polyp is a collection of blood under the surface layer of the vocal fold. This swelling prevents the vocal cords from coming completely together, restricting the ability to sing.)

I have seen many intrepid vocalists not heeding the condition of their bodies and their voices. They try to continue performing when they know something is wrong. A simple problem becomes a complex one and some have then had to deal with the risk and stress of a surgical intervention.

If you are performing and suddenly lose your voice, I recommend the following: stop, look, listen. Stop singing, Look in the mirror and ask yourself, “Is something wrong?” and Listen for the answer. If you have any doubt, go check with a laryngologist.

Prevention is always the best medicine. Solid vocal technique using the minimum amount of air pressure will go a long way to prevent this problem. Another recommendation is to never take Aspirin, Motrin, or Aleve prior to singing as they increase bleeding risk. Although this is not a common problem, knowing the signs and symptoms can help support a healthy decision making process about how to handle the sudden onset of hoarseness after singing.