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Case: Adele

Diagnosis: Vocal chord hemorrhage

British songstress Adele was forced to cancel her 10-city, sold-out North American tour on the heels of wrapping up her tour in the U.K.

Renowned for her powerful vocal deliveries and live performances of soulful tunes like “Rolling in the Deep” and “Someone Like You,” Adele was advised that this extended vocal rest period would help her recover.

For, doctors had diagnosed her with a vocal cord hemorrhage.

While resting in Los Angeles, Adele met with a laryngologist who determined it was imperative that she take the next few weeks to recover with absolute voice rest.

Otherwise, she risked further damaging her distinctive voice.

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What is a Vocal Cord Hemorrhage?

According to Lucian Sulica, MD, of Voice Medicine in New York, a hemorrhage in the vocal cord refers to bleeding in what is known as the superficial lamina propria – the layer of the fold that offers pliability for vibration.

This layer is made up of a network of fibers; when a hemorrhage occurs, blood spreads quickly across the fibers, and the vocal fold is unable to vibrate well.

Hoarseness can be present in the speaking voice or might be heard only in the singing voice; however, there is no pain associated with a hemorrhage and no difficulty swallowing or breathing.

“A hemorrhage may happen to anybody,” Sulica explained. “However, certain situations in which the small blood vessels of the vocal fold may be more fragile may increase the risk.”

These can include upper respiratory infections and chronic use of non-steroidal anti-inflammatory medication, like Motrin or Advil.

“I know that vocalists are fond of using these when they believe their vocal folds are swollen,” Sulica said.

“In fact, there is no evidence they are effective in reducing swelling, and they may actually cause trouble.

“There is also some thinking that vocal fold blood vessels may be more fragile during menstrual periods, but that has not been proven.”

Common Causes

A hemorrhage can result from stress on the voice due to overuse and unhealthy technique.

Blood vessels can rupture and bleed after such singing or when they are in a fragile or swollen state.

Irregularities in the vocal fold, such as polyps or weak areas in the blood vessel wall – called varices – can also serve as causes for a hemorrhage.

This can be an isolated event or, as in Adele’s case, it can be recurring.

In situations of repeated hemorrhaging, the vocal folds are examined for other abnormalities that might be the underlying cause of the repeated bleeding.

How Does a Singer Recover?

Vocal rest, either limiting the voice’s use or discontinuing it all together for several days, is recommended for the vocal chords to mend.

In most cases, this will help a singer recover from a single hemorrhage. However, repeated hemorrhages can suggest an underlying cause – harmful vocal behavior or an irregularity on the vocal fold.

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In these cases, voice therapy is recommended along with microlaryngoscopy to remove or repair the irregularities and to prevent further bleeding.

Preventive Maintenance For All Singers

* Avoid over-singing, that is, singing or straining beyond your voice’s natural capacity.

* If lengthy or strenuous singing has occurred, allow the voice time to rest and recuperate in between performances and other singing engagements.

* Warm up slowly before singing.

* Sing with proper technique and good, low breath support. Seek the instruction of a qualified voice teacher or coach to help you develop this

*Always drink plenty of water to keep your voice hydrated.

Not The End of the Game

While a vocal chord hemorrhage is not ideal Sulica emphasized that it seldom is a career-ender and that singers should seek the appropriate treatment and vocal rest, rather than succumbing to the fear of doing further damage:

“Hemorrhages happen in all types of singers, and in my experience, depend more on the situation than the genre.”

“I think it is important to get the message out that hemorrhages are not rare and very rarely a catastrophe. Most hemorrhages are one-time events that resolve with appropriate voice rest. Even patients with hemorrhages that prove recurrent are almost always able to return to full performance, although in that case, a procedure may be appropriate.”