Vocal Hemorrhage and the Voiceover Artist

Reena Gupta, MD

Those who were in attendance when Osborne Head and Neck Institute hosted Vocal Masterclass IV at SAG-AFTRA got a little more than they bargained for during the live stroboscopy session. Indeed, even as someone who has done thousands of stroboscopy exams, including many live ones for conferences, I was taken aback when my first volunteer had a hemorrhage.

He had volunteered to be strobed because he said he had spent 6 hours the previous day in the booth recording. He said he wanted to know what such intense vocal demand would look like on the cords. It sounded interesting to me as well, although I suspected all we would see was swelling. But when the scope went in, you could hear the collective gasp in the room when a small hemorrhage was seen on the right vocal fold.

What are the take-home points for voiceover artists from this striking case?

1. Symptoms can be subtle – this person had voice fatigue but nothing extreme. It would be expected to be tired after a 6-hour recording day. So how can the artist know if they have a vocal hemorrhage if this volunteer had no symptoms and his voice sounded okay?

This is the important part – he did have symptoms. The day before, during his session, there was one point where he felt suddenly more tired than he had been, about 4 hours in. He pushed to finish his session. The point where he suddenly got a little more tired was probably when the hemorrhage happened. The hemorrhage, therefore, wasn’t totally asymptomatic – it was just a subtlety that he had to ignore due to the session he was in.

Take home point: listen to your body and trust your assessment of it. You don’t necessarily have to stop the session but understand what has likely happened and act accordingly.

2. Resolution can be complete – it is nearly impossible for most voice users to stop in the exact moment that symptoms occur. That’s okay. If you can still get the job done, finish it. And then go on complete vocal rest and reassess in the morning. If it still feels off, you can either get checked out or, if you are able, rest one more day (complete silence). Check in the next day and if the voice symptoms persist, then get checked out.

Take home point: don’t be afraid, be proactive. Rest heals most vocal wounds when done right away. Partner with a laryngologist so you can get in for emergency visits if your symptoms persist.

3. Injury happens from hemorrhages – it’s true that if voice continues during a hemorrhage, scarring or other injuries can develop. However, it would be very uncommon to have this happen in one day. Resting and getting a strobe after should result in a diagnosis and complete resolution without any permanent injury when rest is implemented.

Take home point: Understand how vocal injury happens so you don’t ignore symptoms. Get care sooner, not later.

4. Treatment is possible – in addition to silence, simple measures can be implemented by your laryngologist to ensure that there is no permanent injury. This does require being seen within 1-3 days of a change in voice.

It is easy to say someone should be silent and get checked out for voice changes. The reality of it is not always practical. Between doctor and patient availability and session scheduling, it may not be feasible. My general advice is when the voice feels off, the more silence, the better. Get checked out as soon as you can. Over time, you will start to learn which voice changes really do correlate with injury and hemorrhage and which one were just swelling.

Dr. Reena Gupta, MD FACS, is the Director of the Voice and Swallowing Center at the Osborne Head and Neck Institute (OHNI) based out of the Cedars-Sinai Medical Towers in Los Angeles, CA. Dr. Gupta has devoted her practice to the care of patients with voice and swallowing problems. She is board certified in Otolaryngology and laryngology and fellowship trained in laryngology, with a special interest in the care of the professional voice.

This posting is provided as part of the VO Atlanta Voiceover Conference ongoing effort to provide relevant and meaningful information to members of the voiceover community. Dr. Gupta will be joining us LIVE at the upcoming conference and serves as our resident health expert. If you have not registered already, be sure to do so and join hundreds of other talent, agents, directors, producers, and resource providers from around the world for this special event. https://voatlanta.me

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