What is the risk of hemorrhage in patients with varices compared to those without?
Background: Vocal fold hemorrhage is an acute phonotraumatic injury caused by rupture of lamina propria blood vessels. Varices are generally considered to be especially fragile and prone to rupture due to phonatory vibration. The notion that varices should be addressed surgically appears to have evolved despite the absence of fundamental data regarding incidence of vocal fold hemorrhage and additional risk, if any, related to varices, making treatment efficacy and risk evaluation impossible.
Explore this issue:May 2016
Study design: Retrospective cohort study of 499 patients who were vocal performers presenting for care during a 24-month period.
Setting: Weill Cornell Medical College, New York.
Synopsis: The study’s patient population, limited to performers, demonstrated a markedly higher prevalence of varices than the only extant general patient series. Overall incidence of hemorrhage in the sample was 1.08 cases per 1,000 person-months. The incidence rate of hemorrhage was 3.3 cases per 1,000 person-months in the varix group and 0.5 cases per 1,000 person-months in the nonvarix group. The varix group had a higher probability of hemorrhage throughout the follow-up period (varix group: 2.7% at 10 months, 5.3% at 30 months, 64.4% at 50 months; nonvarix group: 0.8% at 10 months and 30 months, 4.9% at 50 months, 12.2% at 80 months). There was no statistically significant difference in the proportion of patients with varix or patients experiencing hemorrhage between patients with or without mucosal lesions or patients with or without paresis. There was no difference in hemorrhage rate based on varix location on the vocal fold. Limitations included longer follow-up times for repeat patients, who were likely to have more significant voice-related complications. In addition, patients were reassessed at a given interval to verify status only if they presented for care.
Bottom line: The presence of varices increases the risk of hemorrhage, although the overall incidence is low. Neither the varix location, its morphology, nor the presence of other pathology appears to influence the risk of hemorrhage.
Citation: Tang CG, Askin G, Christos PJ, Sulica L. Vocal fold varices and risk of hemorrhage. Laryngoscope. 2016;126:1163-1168.