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Questions and Answers
What characteristic distinguishes a hemorrhagic polyp from a typical nodule?
What is the recommended behavior if a patient is taking anticoagulant medications and has a hemorrhagic polyp?
What is one possible treatment method for a small, early hemorrhagic polyp?
What procedure may be appropriate if there is a recent large hemorrhage resembling a blood blister?
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In a long-standing hemorrhagic polyp, what should be done during surgical intervention?
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What is the primary cause of vocal fold hemorrhage?
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Which facet of vocal capabilities is impacted by a unilateral hemorrhagic polyp?
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What type of behavior most commonly predisposes individuals to unilateral hemorrhagic vocal fold polyps?
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What is a common observation during a laryngeal examination of a patient with a hemorrhagic vocal fold polyp?
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What can a deep capillary rupture in the vocal folds lead to?
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What may chronic vocal overuse lead to in relation to a hemorrhagic polyp?
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Which factor does NOT typically contribute to vocal fold hemorrhage?
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What is a primary characteristic of vocal fold hemorrhage as it progresses?
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Study Notes
Vocal Fold Hemorrhage and Unilateral Hemorrhagic Vocal Fold Polyp
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Epidemiology:
- More common in men.
- Occurs in individuals who engage in intermittent severe voice abuse or work in noisy environments.
- Surprisingly few patients have a history of using aspirin or other anticoagulants.
Pathophysiology and Pathology
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Causes:
- Shearing forces on capillaries during extreme vocal exertion leading to rupture.
- Capillary ectasia increases susceptibility to injury.
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Types:
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Superficial:
- Thin, widely spread superficial bruise without vocal fold margin convexity.
- Little effect on mucosal oscillation.
- Full resolution within 2 weeks.
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Deep:
- Focal blood accumulation, similar to a blood blister.
- Alters margin contour and stiffens mucosa.
- Causes significant and prolonged hoarseness.
- May be the precursor of a hemorrhagic polyp.
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Superficial:
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Microscopic examination of hemorrhagic polyps:
- Shows a rich vascular stroma and areas of hyalinization.
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Unilateral, nonhemorrhagic, pedunculated polyps:
- May be the end stage of a hemorrhagic polyp.
Diagnosis
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History:
- Abrupt onset of hoarseness during extreme vocal effort (e.g., at a party, sporting event, or after a loud sneeze).
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Vocal Capability Battery:
- Varies depending on polyp size, age, turgidity, and pedunculation.
- May present with intermittent and subtle aberrant sounds, impaired or absent falsetto register, or chronic vocal huskiness.
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Laryngeal Examination:
- Unilateral lesion in the node position.
- Contact reaction or nodule on the fold opposite the polyp (in vocal overdoers).
- Hemorrhagic polyp usually larger than a typical nodule, appearing dark and filled with blood in the early stages.
- Discoloration may be at any stage of bruise evolution.
- Long-standing hemorrhagic polyps may lose their vascular appearance and become pedunculated, moving in and out of the glottis with inspiration and expiration.
- During phonation, the polyp may displace upward onto the fold's superior surface, minimally interfering with basic phonation.
Treatment
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Medical:
- Discontinue anticoagulant medications (NSAIDs and warfarin) if possible.
- Control acid reflux.
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Behavioral:
- Short course of voice therapy for voice care instruction.
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Surgical:
- Recent, large hemorrhage: Evacuation of blood through a tiny incision.
- After microsurgical evacuation of hematoma: Interrupt large capillaries within Reinke's space.
- Long-standing polyps: Superficial trimming and spot coagulation.
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Prognosis:
- Excellent for full return of vocal functioning after precision surgery.
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Description
Explore the epidemiology, pathophysiology, and pathology of vocal fold hemorrhage and unilateral hemorrhagic vocal fold polyps. Learn about the causes, types, and implications of these vocal conditions. This quiz is designed for those studying voice and speech pathology.
