What are the consequences of vocal hemorrhages?
Small vocal fold hemorrhages will lead to larger lesions if not identified.
Good technique in speech and singing will definitely reduce the risk of vocal injury. A good team consisting of vocal coach, speech therapist, osteopath and phoniatrist will help guide the Artist in his or her career. The vocal coach and speech therapist will take care of speech adaptations and singing techniques while osteopath and phoniatrist will take care of the functional/muscular set-up of the vocal box.
Early evaluation by a phoniatrician ensures reduction of vocal risk factors. More importantly, vocal cord varices (dilated blood vessels) that form due to overuse or misuse can be identified by videostroboscopy.
They often produce no symptoms, but are precursors to small hemorrhages that can eventually lead to nodules, polyps, cysts, or other vocal lesions.
When varicose veins are identified, they can be treated before they evolve into hemorrhage. They usually occur on the edges of the vocal cords, at contact points, as this is where most of the strain in voice use occurs. Therefore, these vessels will be at higher risk of rupture because they will be subject to a higher number of contacts (blows) during voice use.
When minor bleeding is detected, or even before it occurs, a safe procedure can be performed to remove varicose veins. Recovery is short and easy and it is a low-risk procedure, in contrast is the procedure that would be needed for nodules, polyps, or cyst removal. Recovery in these cases is longer and the procedure itself is riskier. An old American aphorism applies well: An ounce of prevention is worth a pound of cure.
The surgical consequence for any nodules, a polyp, or a cyst is what is seen in artists such as Meghan Trainor, Adele, and Sam Smith. The medical history is the same: a series of missed dates and canceled shows before microhemorrhages lead to a larger injury. Surgery in this case involves a longer recovery.
In an Artist the road to success is arduous and it is unfair to attribute injuries to mere issues of technique or isolated health problems. Repeated close and continuous performances in multiple cities lead to fatigue. A simple cold may be all it takes to push an Artist to develop a minor bleed that is very often impossible for the singer to feel. The only symptoms may be fatigue, which is also a natural occurrence during a tour or continuous performance.
When we focus on preventing vocal damage, with early check-in with a phoniatrist, early intervention for problems, and osteopathic evaluation/balancing, results are better and downtime decreases. These steps may be the best way we have to help singers manage the intense demands of a successful career.
It is now desired to examine the clinical case of one of the above-mentioned Artists in whom a diagnosis of severe vocal hemorrhage was made.
At the time of the onset of symptoms this hemorrhage began to form a polyp on the right vocal cord. The patient in question had initially perceived hoarseness, which her physician had thought to treat by prescribing steroid medication without performing any examination that could rule out injury.
Neglecting this hoarseness, the Artist continued and performed with a subsequent consequence of polyp that resolved with surgery.
After 3 weeks of management and treatment with steroid drugs, this therapy was dropped with a remaining however dilated blood vessel, which is what probably caused the bleeding.
Early treatment of sensitive blood vessels can prevent small and large hemorrhages, thus preventing long-term damage. The indication at this point is for laser treatment to prevent rebleeding. Artists find that this preventive measure saves them from the stress of wondering if there is new bleeding and whether they need to cancel performance dates.
After surgery, reeducation includes working with an experienced vocal therapist to optimize healing and ensure there are no vocal behaviors that cause new varices to form. Concomitant osteopathic intervention cooperates in undoing dysfunctions that may be responsible for certain vocal behaviors.