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Vocal Fold Injury & Recovery

Vocal Fold Injury with Polyp & Hemorrhage

This picture on the left is of my Vocal Folds in 2017 when I was diagnosed with a vocal fold polyp – the little indent on the right hand side. And a vocal fold hemorrhage, which you can see as red on the left hand side of he picture. 

Losing your voice is possibly the worst thing that could happen to any singer / voice professional, but it happens more than we know it.

I have taught voice production & singing for over 10 years in 4 countries. I have two degree’s & 3 diplomas to my name. Not trying to oversell myself here but I hope that I have earned the right to say that I know a little bit about voice use. At least how to take care of my own (Or so you would assume). But I, like so many others, ignored all the signs that something wasn’t quite right & simply pushed through. I am a big preacher of vocal health & maintenance but my vocal injury was a huge wake up call for me. All the knowledge that I had didn’t stop me from developing a vocal fold polyp & vocal fold hemorrhage (double whammy) resulting in 3 months of silence, Dr’s Visits & ending in surgery. This worst case scenario isn’t all doom & gloom. I did not do irreparable damage to my voice, & I want to help remove the stigma around voice injury.

A vocal hemorrhage is the most common injury to occur to professional singers, and one that can result from overuse of the voice or even one aggressive moment of screaming, laughing or belting; particularly when combined with an illness. - Broadway News

4 years ago I suffered from a chest infection & as usual (for me) it turned into a serious cough. So I diligently took to bed for a few days, took my antibiotics, & after a week of rest I continued working. My job after all involves sitting behind a piano, so I simply didn’t demonstrate & kept teaching. No big deal.

My cough however persisted, albeit dry & scratchy, but after visiting the Dr several more times I was told it was simply the aftermath of my chest infection. THIS IS WHERE I WENT WRONG. Persistent coughs MAY be the aftermath of an infection but my persistent cough meant I should have visited the ENT for a check up. As professional voice users we must be cautious of persistent symptoms. According to the UT Southwestern Medical Center information persistent coughs, clearing of the throat & dryness should be checked by an ENT.

I wasn’t performing, I didn’t have any auditions, my voice didn’t need to sound pretty to teach. I had put it all down to being tired & the pesky cough that I still had. After 3 months of illness at this point I couldn’t demonstrate a simple siren or sing a scale. I just put it all down to being tired. Which admittedly I was, teaching 50 hours a week like so many of us self employed teachers do. But I knew after 3 months of voice issues & illness that something was not right. So I shelled out the €400 for the ENT consult myself & my vocal injury was confirmed the next day, as a Polyp & a Vocal Fold hemorrhage. I just sat there & cried, how could I have been so silly. Why couldn’t I hear the signs?

What does a vocal fold hemorrhage feel like?

I would like to add at this point that I didn’t experience any pain, I didn’t have a raspy speaking voice, it was all rather normal to me for someone who taught 40 hours a week & ran a business answering phone calls at each break.

My ENT obviously couldn’t  pinpoint the exact reason for the Polyp but there are a number of reasons for one to occur. A polyp may “appear as a swelling or bump, a stalk-like growth, or a blister-like lesion”. According to the American Speech-Language-Hearing Association, Polyp’s can form due to long term abuse but they can also form due to singular traumatic events – such as coughing.

So how can my experience help you?

There are a couple of things we need to watch out for when singing or speaking professionally. This goes for teachers, fitness trainers, waiters & waitresses, we are all professional voice users: we are required to use our voice to do our jobs. Don’t expect for your voice to just stop working or for blood to come spurting out your mouth (gross). We need to pay attention to the loss of vocal function, which means do a couple of tests for yourself – particularly the siren, SOVT exercises & vowel slides. When these aren’t sounding clear for a couple of weeks then head to your local ENT for a check up.

Signs of a possible vocal injury:

  • Hoarseness
  • Low-pitched voice
  • Breathy voice
  • Inability to speak loudly
  • Frequent ineffective throat clearing.
  • Noisy breathing.
  • Loss of or diminished vocal function.
Female vocalist recording on a microphone
singing student practicing reading music

Vocal Injury Prevention:

  • Warm up & cool down your voice adequately.
  • Rest your voice often – that means no speaking too.
  • Drink enough fluids – water is best. 
  • Get yearly ENT check up’s. 
  • Take note when your voice changes.

Check out this Harvard Medical School info. It provides plenty of information about other types of vocal disorders that voice users can experience. 

Will this happen to me?

It is possible, you never know but if you look after your voice & take care of your instrument then you should for the most part be fine. We need to start seeing vocal injuries like we would view a football player who sprains there ankle. Something that can happen at anytime, to anyone. They are common occurrences for those who use their voices in any capacity, so we need to treat them like that. Absolutely normal.

“You should really watch your vocal technique” – Unhelpful comment.

Lastly, I would like to add that for most professional singers, a vocal fold injury has very little to almost nothing to do with their technique. That is not to say that things can’t develop due to incorrect technique but I am talking about trained voice professionals. 

Famous singers who have experienced vocal injury.

  • Adele: Vocal hemorrhage.
  • Meghan Trainor: Vocal fold hemorrhage.
  • Björk: Vocal nodules.
  • Mariah Carey: Vocal nodules.
  • Celine Dion: Weakness in vocal folds.
  • Whitney Houston: Vocal nodules.
  • Elton John: Vocal nodules.
  • Shirley Manson (Garbage): Vocal nodules.
  • John Mayer: Vocal granuloma.
  • Freddie Mercury: Vocal nodules.
  • Frank Ocean: Vocal fold tear.
  • Luciano Pavoratti: Vocal fold nodule.
  • Frank Sinatra: Vocal fold nodules.
  • Rod Stewart: Vocal fold nodules.
  • Joss Stone: Vocal fold nodules.
  • Justin Timberlake: Vocal fold nodules.
  • Steven Tyler (Aerosmith): Hemorrhage on the vocal fold.
  • Keith Urban: Vocal fold polyp.

Vocal Fold Injury 3 Years on.

In the end my voice didn’t respond to voice rest & antibiotics alone, I ended up having surgery to repair the blood vessels & remove the polyp from my vocal fold. I was then required to stay silent for another two weeks before starting voice therapy.

3 & a bit years on my voice is better than it was before the operation. I have much greater awareness of my voice, pressure & breath than I did beforehand. My very top soprano notes took a little while to come back but any belting, mixed voice & chest voice are easier, freer & more resonant than before. I think it is because I watch out for the signs more than I did.

Look after your voices you lovely singers & have a great day, I hop you find this helpful.

Zoe xx

Zoe Stibi Vocal Coach

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