Vocal Cord Bruising (Hemorrhage)

Vocal cord bruising happens when tiny blood vessels (capillaries) in the vocal folds rupture, allowing blood to leak into the tissue. In addition to a visible bruise, this often causes sudden hoarseness and loss of upper voice.

Common triggers include aggressive or prolonged voice use such as yelling or extremely loud singing, forceful coughing, or a loud sneeze. Occasionally, there is no obvious cause in the patient’s memory, particularly when significant capillary ectasia is present.

There are two main types of vocal cord hemorrhage. To set up an analogy, think of a wet street after rain. If the pavement is new and smooth, with no low spots, the wet surface will dry quickly once the sun comes out. If, however, water collects in a pothole as a puddle, it may take much longer to evaporate—and this also indicates the need for street repair.

Returning to bruising, a superficial hemorrhage consists of a thin suffusion of blood very near the surface of the vocal fold (wet pavement). There is no change in the vocal fold margin, and vibration under strobe light can be normal, which explains why the voice is often only minimally affected. The bruise typically disappears rapidly.

If, on the other hand, there is ad “street puddle” of blood, like a micro–goose egg or “blood blister,” absorption occurs much more slowly. This type of hemorrhage may evolve into a polyp and can require removal of a residual lesion.

Initial Treatment

Once the type of bruising has been identified (thin suffusion versus blood blister or hemorrhagic polyp), the patient typically rests the voice for several days. Voice use should be minimal, though absolute voice rest is not usually necessary. Other general measures of voice care—such as good hydration and reflux management when present—are advisable.

A follow up visit can be useful within a short time if a superficial bruise, and the person can often resume voice use, including vocal performance, before all traces of the bruise have absorbed. A longer interval for reexamination makes sense for hemorrhagic polyps, since recovery is expected to take much longer.

After any vocal fold hemorrhage, follow-up examination is important, even if the voice becomes normal. The purpose is to look for an ectatic capillary, an abnormally enlarged surface blood vessel. These fragile vessels increase the risk of repeat hemorrhage and, if unidentified, may remain silent until another bruise occurs. For this reason, identification and prophylactic treatment, as described below, are strongly recommended.

If an ectatic capillary is found after resolution of the bruise, laser coagulation is often recommended, either in the office or the operating room. Commonly used lasers include CO₂, KTP, thulium, or blue laser systems. While the choice of laser is of some interest, the surgeon’s experience and judgment are more important; lasers tuned to the wavelength of hemoglobin (such as pulsed-KTP or blue laser) are theoretically ideal, but the CO₂ laser can also work very effectively.

If a blood blister becomes a persistent polyp, microsurgical removal may be needed. This is most often performed in the operating room, although in selected cases an office-based laser approach may be appropriate. With modern surgical techniques and an experienced surgeon, voice quality is almost always fully restored.

Prognosis Summary

Superficial bruises resolve rapidly without permanent damage. Blood blisters or hemorrhagic polyps recover more slowly and may require microsurgical repair, but in both cases, with expert care, outcomes are excellent, commonly returning the voice to its original capabilities.