Vocal Hemorrhaging – Vocal Bruising and Injury

Vocal bruising– the beginning of voice injury

Vocal bruising (also called a hematoma or, inaccurately but commonly, a hemorrhage) occurs when a small blood vessel in the vocal cord ruptures and leaks blood into the vocal cord tissue.

It is similar to getting a bruise anywhere else, such as a black eye, and happens when there is trauma to the tissue.

Trauma happens when vocal cord contact is forceful enough to injure a vocal blood vessel. This does not happen easily but the odds increase when the vocal cords are swollen, such as from smoking, reflux, overuse, allergies, illness, etc. A sneeze, cough, or loud belt can be forceful enough to rupture a vocal vessel.

Vocal bruising is serious because the bruise sets up a chain reaction of inflammation. This is the body’s attempt to heal the tissue and “clean up” the mess from the bruise. But if there is continued voice use during the cleanup process, it produces injuries, such as polyps and nodules. The only way to stop the chain reaction is to go on complete vocal rest. 

While bruising is not that uncommon for me to find in my practice of professional voice users, every once in a while, one shakes me up. I’ll never forget the year that I found one in front of an audience of over a hundred voice users. Every year, I run a vocal education conference with a live stroboscopy course. That year, a voiceover artist volunteered to be scoped because he had had a long session the day before and felt vocally tired. As the scope went in, the entire audience saw a bright red bruise blooming on his vocal cord. 

While this was far from the ideal way to discover a bruise, this volunteer was lucky that it was detected. This discovery allowed him to go on vocal rest and recover completely.

At the time, we were concerned that he seemed to have had no symptoms that could have predicted this. But we discussed this further in his follow up (in an office this time, rather than an auditorium) and I realized that he did have symptoms. 

His fatigue hadn’t concerned him, given his tough VO session the day before. But he later recalled that, during his session, he felt more tired at one point, about 4 hours in. The bruise likely occurred then, so it wasn’t totally asymptomatic. He was still able to finish his session on that day but he’ll recognize this symptom if it happens again.

If you notice a change in your voice during a session, finish your session if you’re able. While you may have bruised, it is likely okay to finish. But after the session, go on complete vocal rest. 

If your voice is back to normal in the morning, it likely wasn’t a bruise. But if not, take a day of rest and check again the following day or get checked out. 

Injury starts with vocal bruising. However, injury takes several days, with continued voice use, to develop. Injury rarely develops within the same session during which bruising happens. Rest your voice when it feels off and if, after 2-3 days of vocal rest, you’re not back to normal, get an evaluation with a laryngologist. While voice rest is the first step, I may recommend supplements or other treatments based on what I see when I evaluate you. 

While bruising looks scary, when detected and treated, artists will fully recover. Partnering with your laryngologist will allow you to get on the path to recovery quickly.