Physical stresses caused by voicing behaviors such as shouting, throat-clearing, and coughing may lead to the rupture of the tiny blood vessels in the vocal fold resulting in bleeding (Hemorrhage) into the outer layer of the vocal fold. The proper vibration of the vocal fold is altered due to the blood in the outer layer.


The hoarseness caused by Hemorrhage usually develops over a very short period of time. Hemorrhage often occurs as a result of a specific event that required strenuous use of the voice such as a musical performance or speaking loudly. There is no pain associated with vocal fold hemorrhage; hoarseness is often the only symptom.


For isolated incidents, voice rest is usually the only treatment needed. With time and decreased use of voice, the collection of blood in the outer layer of the vocal fold resolves and the voice returns to normal.

For recurrent Hemorrhage of the vocal fold, the underlying cause must be investigated and treated. If misuse of the voice is the source of the repeated vocal fold Hemorrhage, voice therapy may be useful.

If the repeated Hemorrhage is caused by irregularity of the vocal fold, micro-laryngoscopy may be necessary to remove or repair the irregularities or blood vessels prone to bleeding. Micro-laryngoscopy is the most precise means of operating on the vocal folds. All surgery is done under general anesthesia via a laryngoscope, an instrument inserted through the mouth to view the larynx directly. There are no skin incisions. A microscope is used for magnification of the field of surgery and micro-instruments are utilized.