- There are many things that can go wrong with the voice.
Now most vocal issues develop
over an extended period of time.
Nodules, for example, may take months to fully develop.
There is one vocal pathology, however, that can develop
in an instant, vocal fold hemorrhage.
What is a vocal fold hemorrhage, and what can you do
if you have received this distressing diagnosis?
I've got some helpful thoughts coming right up.
- [Voiceover] Sound check.
Check one, check two.
(applause)
(upbeat music)
- Good day everyone!
Welcome back to Voice Essentials.
It's so good to see you again.
If you're new to my channel, hi.
My name is Dr. Dan,
and I'm a contemporary singing voice specialist.
It's my job to help you realize the full potential
of your singing voice.
Now it's also my job to assist in the rehabilitation
of sick and damaged voices.
As I stated at the start, many things can go wrong
with your vocal apparatus.
Some voice disorders, such as vocal fold hemorrhage,
can strike any singer at any time.
Voice damage, what many modern voice care professionals
prefer to call vocal disturbance, is not always due
to self-imposed vocal abuse.
So if you've recently received the diagnosis
of vocal fold hemorrhage,
I hope the next few moments will prove informative
and reassuring.
If you're a regular to my channel,
you'll notice that this is a re-edit
of a video some weeks back.
The previous video prompted some updates to my knowledge
from respected colleagues, and so, I thought it prudent
to update the information.
Thus, you're now watching the new and improved version.
And a quick qualifying statement as we proceed,
I am not a medical doctor.
My doctorate of musical arts is in the area
of learning and teaching.
So it's important for me to state from the outset
that any diagnosis of voice disorders should only
be performed by a registered ear, nose, and throat doctor,
preferably a laryngologist who specializes in the care
of the human voice.
The information that I'm about
to provide is purposefully general in nature,
and is designed to encourage you towards
better vocal health.
I think when most singers think about vocal injuries,
nodules immediately come to mind.
Nodules, what some people might call nodes, are serious,
but as I said before, they typically develop over
an extended period of time.
A vocal fold hemorrhage, however, is different.
Perhaps one of the more debilitating functional disorders
of the voice in the acute stage,
the dictionary for the modern singer explains
that a vocal fold hemorrhage is a type of voice disorder
that occurs when a blood vessel ruptures
within the vocal folds.
Vocal fold hemorrhages are generally caused
by trauma or abuse.
After a hemorrhage, the voice will quickly become impaired
due to blood accumulation in the vocal fold,
which prevents normal mucosal wave formation.
This seems to have been the case for Adele.
In her 2015 interview with 60 minutes,
Adele described the sensation of her vocal fold hemorrhage
as "literally like someone switched a click off
"in my throat, like someone put a curtain over my throat."
A vocal fold hemorrhage is the rupture of capillaries
either within the lamina propria, that is the middle layer,
or the epithelium, the outer layer, causing bruising
of the vocal fold.
As we observe in this footage,
the bleeding impedes the normal vocal fold oscillation,
and if left untreated, can lead to significant scarring.
(vocalizing)
- [Voiceover] Sound check.
(applause)
- As you can see,
a vocal fold hemorrhage is a pretty serious matter.
So how do vocal fold hemorrhages occur?
Good question.
A vocal fold hemorrhage can happen due
to sustained extreme voice use, and it can also happen
in an instant when the voice is vulnerable during times
of sickness, menstruation, or from a simple stifled sneeze,
for example.
Again, the severity
of the vocal fold hemorrhage is determined
by the depth of the bleed out.
Superficial bruising of the outer layer of the vocal fold
will frequently leave the oscillation
of the vocal fold unhindered.
This kind of light bruising will often self-resolve
with extended vocal rest of a few weeks or so.
If, however, the bruising extends deeper
into the middle layer of the vocal fold,
then the singer will almost certainly experience
a disruption to their ability to create vocal sounds.
And Leda Scearce,
a leading singing voice specialist, explains,
"Rupture of a deeper capillary with extravasation
"of blood into the vocal fold leads to stiffness
"of the vocal fold and potentially an altered contour
"to the medial surface, called a hemorrhagic polyp."
It's important to also note that a vocal fold hemorrhage
can, at times, also be non-symptomatic.
That is, a singer can experience a hemorrhage
in the superior surface of the vocal fold
that is away from the leading edge of the fold,
and this means their voice may not experience
any noticeable disruption.
Regardless of depth, a vocal fold hemorrhage,
unlike nodules, for instance, where continued voice use
with altered finatery patterns, may prove beneficial.
The singer who experiences a vocal fold hemorrhage
will almost certainly need to observe a period
of absolute voice rest in accordance
with the directive care of a laryngologist
and a speech pathologist.
You see, unlike nodules, continued voice use may heighten
the risk of re-bleed.
Just like any other significant bruise on your body,
a vocal fold hemorrhage needs time to resolve and heal.
I've got a few tips on how to care for your voice,
both when seeking to avoid a vocal fold hemorrhage,
and when needing to care for the voice after a diagnosis
of vocal fold hemorrhage.
But before I list them off for you,
please take a moment to hit the thumbs up button
if you're enjoying today's video, and it's proving helpful.
- [Voiceover] Sound check.
(applause)
- Rest assured, a vocal fold hemorrhage does not
and should not spell the end of your singing career,
professionally or otherwise.
But as if often the case, prevention, where possible,
is better than cure.
So what can we do to lessen the risk
of this challenging form of voice disturbance.
Well, firstly, consider the way you're using your voice.
Sustained extreme vocal practices such as power ballads
which use belt,
and genres that employ distorted voice like metal
and screamer are best performed by singers
who have established a solid foundation
of task specific technique.
Just stepping onto the stage and screaming your head off
for extended periods of time
without any technical foundation places your voice
at higher levels of risk.
Singing when you're sick is also ill advised,
because when you have a cold or flu,
your vocal folds are likely to be already swollen,
either due to direct infection or an accompanying cough.
And when we choose to sing on already swollen vocal folds,
we risk further exacerbating the swelling, which in turn,
heightens the risk of vocal fold hemorrhage.
Ladies, you have the added challenge of your menstrual cycle
to contend with.
Hormonal fluctuations may lead to swelling
of the vocal folds,
and as respected laryngologist,
Dr. Robert Sataloff explains,
"Submucosal hemorrhages in the larynx are more common
"in the premenstrual period."
Premenstrual voice syndrome is a very real thing
for about one third of women, so ladies,
pay particular attention to the care of your voice
in the days leading up to and including menses.
And of course, if you believe your voice is not recovering
like you know it would normally
directly following your period,
then seek medical advice as soon as possible.
And here's an interesting one.
Always try to avoid stifling your sneezes.
When we stifle a sneeze, we place tremendous pressure
back against the vocal folds.
A single stifled sneeze can burst many capillaries
within the vocal fold, so always let your sneeze occur
in an unrestricted way.
Also, unrelenting cough can prove to be traumatic
for the vocal folds.
So if you have a consistent cough, please see your doctor
who should be able to help you resolve the cough's trigger.
Finally, do your best to avoid singing
with blood thinning agents in your system.
Drugs such as aspirin and ibuprofen should be avoided
when placing the voice under extreme loads
for extended periods of time.
And if you have experienced a vocal fold hemorrhage,
then Leda Scearce suggests,
'Supplements with garlic, ginkgo, ginseng, ginger,
"or fish oil can affect coagulation and should be stopped."
Allow me to once again reassure you, especially
if you currently suspect you've had a vocal fold hemorrhage,
that not all is lost.
I strongly recommend seeing a laryngologist
for a full assessment of your current vocal condition.
Left unattended, a vocal fold hemorrhage can
become a bigger problem.
But if you respond immediately with voice rest
and good voice therapy,
then your singing future remains bright.
Remember the footage I showed you earlier displaying
a vocal fold hemorrhage,
here's the same voice one week later,
after the hemorrhage has resolved with medical intervention,
including assessment, diagnosis and rest.
(humming)
The voice can recover after a vocal fold hemorrhage
with the right diagnosis followed by the right care
and attention.
Again, do everything you can
to avoid developing a vocal fold hemorrhage,
but if, like Adele, you feel a sudden click or change
in your throat and sound,
or even if you don't necessarily feel anything significant,
but you suspect your voice is not performing like it should,
stop singing immediately, and seek a full vocal assessment
from a laryngologist at the first available opportunity.
As always, I hope today's video has been educational.
Leave me any comments below outlining
your personal experiences,
and further questions you might have when it comes
to vocal fold hemorrhages.
And before I go, if you are new to my videos,
then please take a moment to check out my channel
for more videos designed to develop your voice
and improve your sound.
Voice Essentials is a global community of singers
who encourage each other in the development
of their singing.
We hope you'll join us.
I'll see you again soon.
I'm Dr. Dan.
Sing well.