Current Management of Vocal Fold Hemorrhage: A Survey of American Broncho-Esophagological Association Members.

Objective: To determine practice patterns for the management of vocal fold hemorrhage (VFH).

Study design: Cross-sectional survey.

Methods: American Broncho-Esophagological Association (ABEA) members were queried regarding VFH management paradigms. Clinical scenarios involving uncomplicated VFH and VFH with associated mucosal pathology were posed. Participants were asked about their threshold for procedural intervention and experience with the evolution of uncomplicated VFH to VF scar and hemorrhagic polyps.

Results: Fifty-six responses were obtained by in- or post-training physicians, all of whom indicated laryngology as their principal focus. The majority of respondents had been in practice for less than 15 years (71.4%) and worked in an academic setting (96.4%). Most recommended voice rest for both uncomplicated VFH (96.4%) and VFH with associated mucosal pathology (85.7%) for an average of 7.3 ± 2.2 and 7.0 ± 6.4 days, respectively. For both clinical scenarios, roughly one-quarter of respondents prescribed steroids. Voice therapy was more likely to be recommended for VFH with associated mucosal pathology (69.6%) compared to uncomplicated VFH (26.8%). The majority would intervene procedurally on a VF varix/ectasia following one (33.9%) or two (55.4%) episodes of associated hemorrhage, typically with an angiolytic laser in the operating room (55.4%) vs. office (41.1%) setting. Respondents indicated that a minority of uncomplicated VFH cases evolve to become VF scar (average 9.4% ± 8.2%) or hemorrhagic polyps (18.3% ± 12.8%).

Conclusion: Most surveyed ABEA members advise one week of voice rest for VFH, voice therapy for VFH with associated mucosal pathology, and angiolytic laser treatment for VF varices/ectasias following recurrent hemorrhage episodes.

Level of evidence: V.