Vascular Lesions:
Vocal Hemorrhage, Hematoma, and Varix
Vocal Hemorrhage
Vascular vocal fold lesions, including hemorrhage, hematoma, and varix occur due to some traumatic (usually sudden onset) injury to the small blood vessels of the vocal fold. Often, a hemorrhage occurs when a small blood vessel on the top surface of the vocal fold breaks causing bleeding into Reinke's space. A hematoma is the accumulation of blood that has leaked from the vessel. A varix is a mass of blood capillaries that appears as a small, longstanding "blood blister" that has hardened over time. It may also appear as a blunt end of a varicose vein, seen on the surface of the vocal fold after the hemorrhage has resolved.
All of these resulting injuries create stiffness in the mucous membranes. In the most severe cases, scarring of the vocal fold cover may occur. This scarring may cause significant sudden onset of severe hoarseness at the time of the bleed. Often the hoarseness lasts for a long period after the injury. The effects on voice vary, depending upon the extent and length of time since the onset. A varix in the nonprofessional voice is usually not cause for concern. However, even this slight disruption in normal vocal fold function may be significant for those who depend on their voices professionally.
The treatment of choice is strict voice rest and conservation, which, in most cases, results in spontaneous resolution of the hematoma. Without care, the treatment may yield a worse result than the original problem. Other treatment for these vascular lesions may include a rapid course of steroids, or, in the case of an unresolved varix, microexcision of the lesion using careful laser vaporization. Voice therapy following resolution of these lesions is useful to restore voice quality, endurance, and range.