Acute Vocal Fold Hemorrhage While Singing

A 40-year-old female opera singer presented to the phoniatric department due to hoarseness resulting from vocal strain. The soprano described intermittent functional impairment to her singing voice (dysodia) since changing from lyric to dramatic voice type (fach) a few months previously. Transoral videolaryngostroboscopy revealed a marginal edema of the right vocal fold (arrow) with supramarginal varices (vocal cord varix; asterisk). In contrast to other varices, such as for example in the esophagus, these are caused by strain rather than congestion. During the examination, subepithelial hemorrhage occurred in the region of the middle third of the vocal fold (arrowhead) while the patient used her singing voice. After several weeks of vocal rest and hematoma resorption, phonosurgical microlaryngoscopic resection of the residual vocal fold edema and vocal fold varices was performed. Postoperative follow-up showed functional recovery of phonatory vocal fold mobility with complete glottic closure and restored performance. Given the low incidence of vocal fold varices, no cases of variceal hemorrhage directly during transoral videolaryngostroboscopy have been described in the literature to date. The present case illustrates that vocal fold varices can lead to recurrent organic voice dysfunction due to strain-related tissue hemorrhage, particularly in elite vocal performers.

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Prof. Dr. med. Philipp P. Caffier, Prof. Dr. med. Tadeus Nawka, Klinik für Audiologie und Phoniatrie, Charité – Universitätsmedizin Berlin, [e-mail]

Dr. med. Sebastian Weikert, Forum HNO, Gemeinschaftspraxis für HNO und Phoniatrie, Regensburg

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Caffier PP, Weikert S, Nawka T: Acute vocal fold hemorrhage while singing. Dtsch Arztebl Int 2023; 120: 114. DOI: 10.3238/arztebl.m2022.0356