Capillary ectasia

Capillary ectasia is the enlargement or dilation of capillaries on the surface of the vocal cords. Some believe it to be an estrogen effect similar to “spider veins” that one might see on the legs, for example. At our practice we think of these as mainly being another manifestation of overuse of the voice, and a response to ongoing injury of the vocal cords.

Once established, it may cause symptoms of reduced vocal endurance and exaggerated premenstrual huskiness. Capillary ectasia may also increase the risk of vocal cord bruising (hemorrhage) and hemorrhagic polyp formation. Many affected individuals, however, may “coexist” with this when armed with appropriate information about this disorder and through carefully managing amount and manner of voice use. When indicated, it is easily corrected via vocal cord microsurgery.

Photos of capillary ectasia:

Red Herring Capillary Ectasia and Mucosal Injuries

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ectatic capillary of the left vocal cord

Ectatic capillary (1 of 4)

This young performer has a sense of a weakened voice and loss of vocal stamina. Here, we see an ectatic capillary of the left vocal cord (right of photo). Is the problem intermittent vocal hemorrhage from this vulnerable capillary? Is there increased susceptibility to edema due to this margin capillary?
Ectatic capillary

Ectatic capillary, narrow band light (2 of 4)

Under narrow band light, the capillary is even more evident. The additional network of prominent capillaries prompt the same questions as in caption 1.
subtle margin swelling

Margin swelling (3 of 4)

Under strobe light at B-flat 4 (494 Hz), we see subtle margin swelling (arrows), here of only “indicator lesion” magnitude.
arge amplitude of the open phase of vibration

Bowing, atrophy, and flaccidity (4 of 4)

The large amplitude of the open phase of vibration at the same pitch, along with the lack of closure in photo 3, reveals the actual problem to be bowing, atrophy, and flaccidity. These findings fit with the “bowing” symptom complex: loss of edge to voice quality and the tendency of voice quality and strength to “fade” as the day progresses.


Capillary ectasia (including KTP laser treatment)
This video illustrates the various causes of capillary ectasia and the treatment options that are available to patients, including pulsed-KTP laser treatment.
Nodules and Other Vocal Cord Injuries: How They Occur and Can Be Treated
This video explains how nodules and other vocal cord injuries occur: by excessive vibration of the vocal cords, which happens with vocal overuse. Having laid that foundational understanding, the video goes on to explore the roles of treatment options like voice therapy and vocal cord microsurgery.