Vascular Lesions: Vocal Hemorrhage and Varix

What are vascular lesions?

Vascular vocal fold lesions occur due to a traumatic (usually sudden onset) injury to the small blood vessels of the vocal folds. A vocal hemorrhage often occurs when a small blood vessel on the top surface of the vocal fold breaks, causing bleeding into the layer under the surface lining of the vocal fold known as Reinke’s space. A varix is a mass of blood capillaries that looks like a small “blood blister” that has hardened over time.

What are the symptoms of vascular lesions?

A hemorrhage often causes sudden and significant hoarseness. For some however, a hemorrhage may not change the voice significantly.

A varix may not change the voice significantly or at all depending on its placement. A varix on the vibrating edge of the vocal fold will tend to cause more significant hoarseness than one formed elsewhere. For a non-professional voice user, varices are typically not of concern. However, for those who rely on their voice for a living, even a small disruption in normal vocal fold vibration may be significant.

How are vascular lesions treated?

The ideal treatment for a hemorrhage is one week of strict voice rest, followed by conservative voice use for a bit more time depending on how the vocal folds have healed. Typically, this will allow for spontaneous resolution of the hemorrhage. In some cases, a vocal fold will continue to show signs of hemorrhaging which will call for the need for cauterization of the blood vessel within the vocal fold that continues to bleed.

Treatment for a varix can vary depending on the effect it is having on a patient. Some varices never cause voice issues and those need no treatment. Other varices may cause a hemorrhage to occur or may be interfering with vibration, and in those causes these can also be cauterized in the operating room.