Vocal fold hemorrhage: when vocal fold blood vessels are not up to the task!

The human voice is complex and unique. It expresses extremes of emotion, communicates thoughts and needs, is elicited in moments of physical pain or joy, and in many cases is the first victim of tension or poor vocal technique. Patsy Rodenberg elucidated this point well in her book, “The Need For Words” (1993), as she highlighted the elemental need to release the inner voice in the quote above. In the vocal arts, voice is one’s brand, easily recognizable, and sadly in many cases, taken for granted until an episode of pathology jars awake the complacent user. For performers and other professionals involved with voice production, the concept of a “voice emergency” is an all too familiar event that highlights the vulnerability of vocal health. This discussion will focus on vocal fold hemorrhage ... also known as the “do you have an understudy for the next 7–10 days” conversation many performers have with their friendly ear, nose, and throat physician. A hemorrhage is a profuse discharge of blood from a ruptured blood vessel. Another definition of hemorrhage reflects a loss of assets (as in hemorrhaging money), especially in large amounts. Both definitions are especially meaningful to the professional voice user as consequences of continued voice use in the presence of a vocal fold hemorrhage that may cause permanent vocal damage and therefore loss of income. Linklater (2006) highlighted this paradox well in that “actors must train their voices so that they can sacrifice them.” As medical practitioners of vocal health, our opinion is that this sacrifice is sometimes unnecessarily rooted in the classic mantra, “the show must go on” ... and in many cases, the show can go on, but with delicate attention to vocal behavior and a close relationship with a medical team equipped to serve the needs of the prized vocal mechanism. A brief review of normal vocal function reminds the voice user that voice is produced when two small, layered folds of tissue overlying a muscle begin to vibrate