From Robert Bastian:
“When a vocal fold hemorrhage happens, three patterns of bruising can happen. Let’s use rain on pavement as an example. The first kind of bruising is a thin suffusion of blood that discolors but does not appreciably accumulate or thicken the mucosa. It is like wet pavement on the crown of the road. There is no actual “thickness” of water making the pavement wet, and this explains why, when the sun comes out, the pavement dries very quickly.
“A second kind of hemorrhage is like rain in a shallow, low spot on the road,” Bastian continued. “Perhaps a quarter-inch of water sits on the pavement in this area after the rain. When the sun comes out, it may take a day or two to completely dry up.
“The third kind of hemorrhage is like water accumulating in a deep pothole. Imagine that the water is standing 8 inches deep. It may take a week or more for the water to evaporate. Or, it may never fully resolve without intervention. Many who experience the third kind of hemorrhage develop a polyp. It looks like a blood blister on the surface of the vocal fold. Even if after many months, the blood re-absorbs from the “blood blister,” a non-discolored polyp – like a blister without the blood – may persist.”
“Traditional mircolaryngoscopy is a brief outpatient procedure done under general anesthesia,” Bastian explained. “After the singer is asleep, a hollow, lighted “tube” allows the surgeon to bring the vocal folds into view. Tiny instruments and/or a laser are used to spot-coagulate the ectasia or to remove precisely and superficially a persistent hemorrhage polyp.”
In recent years, optional techniques can sometimes be used in an “office” setting, with a patient sitting in a chair with his or her throat sprayed with topical numbing medicine, Bastian added. High-tech video-endoscopes with coupled lasers are used to deliver tiny bursts of laser energy down an optical fiber.
“When hemorrhage occurs in a singer, a number of questions need to be answered. First, is this a unique event? If so, it may be a one-time fluke, or it may serve to point out that the singer is living ‘on the edge’ vocally.”
A voice-qualified speech/language pathologist may assist the singer to alter many things, including amount and manner of voice-use. Surgery can be necessary if capillary ectasia (enlargement or dilation of the capillaries on the surface of the vocal folds, similar to “spider veins” –another manifestation of overuse of the voice and ongoing injury of the vocal folds) is found and especially if the singer has experienced more than one hemorrhage.
Another scenario for surgery might be when the bruising event leaves behind a persistent polyp; this surgery can happen as a brief outpatient procedure and sometimes even in an office setting.