The rupture of one or more capillaries in the vocal folds, with leakage of blood into the tissue. This capillary rupture and bruising occurs as a result of excessively vigorous mucosal oscillation, usually during extensive or vigorous voice use, aggressive coughing, or even a very loud sneeze, and it can make the voice hoarse or otherwise limited.
If the ruptured capillary is extremely superficial, like the capillaries seen on the white of the eye, then a “thin suffusion” kind of bruise occurs, and there is no deformity of the vocal fold margin; within a few days, the voice recovers surprisingly. If the vessel is a few cell layers deeper into the fold, then a small “puddle” of blood like a micro-hematoma may collect and create a kind of “blood blister.” Although a superficial bruise resolves quickly and doesn’t seem to cause permanent damage, the “blood blister” type can become a hemorrhagic polyp and require surgery; with state-of-the-art surgery, however, the voice can virtually always be restored to its original capabilities.
Bruise / hemorrhage, vocal fold (1 of 4)
Bruise, right vocal fold (left of image), estimated one week old, in combination with large polypoid vocal nodules. Note the yellowish discoloration, indicating partial breakdown of the hemoglobin (source of red color of blood) into hemosiderin as bruise is beginning to be cleared away.
Bruise / hemorrhage, vocal fold (3 of 4)
Bruise was allowed to resolve, and then patient underwent vocal fold microsurgery one week prior to this examination.
Bruise / hemorrhage, vocal fold (4 of 4)
Same patient, during phonation. Note the patient’s tendency to phonate with a gap between the folds, as though the vocal folds “remember” the early contact that used to require separation during voicing. This gap can be lessened through expert speech (voice) therapy.
Bruise / hemorrhage, vocal fold (1 of 2)
Bruise, left vocal fold (right of image), estimated three weeks old, in combination with vocal nodules, capillary ectasia. There is likely an ectatic capillary also on the same side, within the nodule, that is the source of the leaking of blood into the tissues. When the bruise first occurred, it would have been most evident in the area of the nodule. As time passes, the central part of the bruise typically resolves first, with the last area to disappear anterior and posterior, as shown here. Note also the faint yellowish discoloration of the left fold, indicating residual hemosiderin (breakdown products of blood in tissue).