What is the long-term impact of vocal fold hemorrhage (VFH) on vocal function and health, particularly compared with similar patients who have not had VFH?
Bottom line
Contrary to commonly held belief, VFH appears to have no significant long-term impact on vocational stability, subjective voice quality, or vocal function perceptions.
Vascular lake on the lateral half of the superior surface of the right vocal fold. Medial to it is a linear varix.
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Background: VFH’s rapid onset and dramatic appearance is a source of considerable anxiety to patients, a situation often compounded by VFH frequently being discussed in catastrophic terms. It is generally believed to cause permanent voice change by means of scarring of the lamina propria. Despite this, there are no systematic studies of the consequences of VFH, and reports of cases of scars clearly attributable to VFH are uncommon.
Study design: Retrospective cohort study of 41 patients with a history of adult VFH diagnosed between April 27, 2006, and May 13, 2014, and 53 control patients.
Setting: Weill Cornell Medical College, New York City.
Synopsis: Control and VFH groups did not differ in age, gender, performer status, follow-up duration, or non-VFH vocal fold pathology. Nine VFH patients had more than one hemorrhage, and three underwent microlaryngoscopy related to VFH. VFH and control groups were substantially similar in most outcome parameters except days of work missed—VFH patients were significantly more likely to report more than seven days of work missed per year due to a voice problem. No significant differences were found between groups for statements from the Likert scale questions regarding vocal function, VHI-10, and Singing Vocal Handicap Index. There were no significant differences between single- and multi-event VFH patients in continuation in profession, missed work days, or most items on the Likert questionnaire.
Multi-event patients were significantly more likely to agree with the statement, “I have knowledge and resources to manage any future voice problems, should they arise.” The majority of patients in both the VFH and control groups strongly agreed with the statement, “I can participate in my profession without vocal limitation.”
Citation: Kerwin, LJ, Estes C, Oromendia C, Christos P, Sulica L. Long-term consequences of vocal fold hemorrhage. Laryngoscope. 2017;127:900–906.