Voice Rest - How long for polyp/hemmoraghing for young singing student?

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Dear Dr. Thomas,

One of my young students (age 12) developed a polyp/hemmoragh in early November from screaming/crying when she fell back and hit her head on the sharp table corner.  Her singing up to that point was wonderful, with a 3.5 octave range, clarity, etc.  Her singing voice was compromised greatly because of the screaming/crying event.  I heard it right away when they called me the day after it happened, - her range was cut in half and the sound was raspy.  The doctor to whom she went to, only advised her to be on voice rest for one week.  After one week, she came to me for her voice lesson, but it was obvious that she was nowhere near vocal recovery, (so, no voice lesson).  She went back to the laryngologist and they/he said to have a second week of voice rest.  She did this, and after the second week, her voice was still nowhere near vocal recovery.  Yes, I have seen photos at different stages of the recovery.  A few days ago, she came in for a voice lesson, this time after about three sessions with a voice therapist working on breathing and airflow with lip trills, sound/no sound airflow exercises, etc., and still, the photo showed a slight swelling on either side of the cords where the polyp had been.  Firstly, I do not understand why the doctor would have her receiving voice therapy when her cords are still swollen.  Secondly, I do not understand why the doctor would have given her only one week of voice rest, then followed by only a second week of voice rest.  In other instances, I am familiar with singers being totally silent for a month or even two, just to give the polyp and bleeding the best possible opportunity to heal completely, before beginning any type of voice therapy.  Does voice therapy aide or hinder the recovery of still swollen vocal cords?
James P Thomas MD's picture
Submitted by James P Thomas MD on Sat, 2012-04-07 13:48

 

Dear voice teacher,

 

When there is a sudden loss of voice, the problem is usually related to blood vessels and hemorrhage. If that was the case with your student, the amount of time for recovery is quite variable, although one week would almost certainly be too little for blood to absorb and a blood vessel which was broken to heal. Secondly, if a blood vessel was involved, it is not clear to me that any type of exercise can promote healing of such a blood vessel.

 

This is in contrast to chronic vocal overuse which tends to produce a thickening of the skin, otherwise known as a vocal nodule(s). Appropriate therapy can be initiated to alter vocal behavior and perhaps diminish vocal trauma, in the long run reducing the size of the vocal swellings.

 

One can still sing with a hemorrhagic polyp, the risk of re-breaking the polyp is just higher and the voice is likely impaired to some degree. Some people are willing to take that risk. Quite frequently hemorrhage will reabsorb into the body. In contrast, once a hemorrhagic polyp is formed, in my experience this usually requires surgery to remove it, along with a number of weeks of recovery afterwards. The good news is that, if a hemorrhagic polyp formed from a vocal accident, there is usually no underlying inappropriate use of the voice so that once healed, no specific therapy is needed to alter voice use. Regular voice lessons can just be resumed.

 

The best way to know what is going on is to have a good close examination, something I talk about in several videos. I have tried to list the physicians I know who are highly interested in the voice elsewhere on this website: http://www.voicedoctor.net/physicians.