[Etiopathogenesis and therapeutic tactics of hemorrhages in the vocal fold in persons of voice-speech professions].

Objective: To increase the effectiveness of treatment of patients with vocal fold hemorrhage based on the analysis of the disease etiology.

Material and methods: In order to improve the treatment efficiency of vocal fold hemorrhage in people with voice and speech professions, 112 patients (35 men and 77 women) with vocal fold hemorrhage were examined and treated. Age from 24 to 58 years. Research methods: questionnaires, microlaryngoscopy, videolaryngostroboscopy, acoustic voice analysis (Kay Pentax system).

Results: All patients complained of hoarseness. A change in voice that appeared during vocal exertion using a harsh sound attack was noted by 47 (42%) patients, while screaming - 13 (11%), during coughing on the background of acute respiratory viral infection and exacerbation of chronic destructive lung disease - 27 (24%), after fibrolaryngobronchoscopy - 3 (2%), after esophagogastroduodenoscopy - 1, after external neck injury in everyday life - 2 (1%), during the usual volume and intensity of vocal load - 19 (17%). Microlaryngoscopy revealed hemorrhage in the vocal fold in all patients, with 85 (76%) patients experiencing hemorrhage for the first time, 17 (15%) - repeatedly, for 10 (9%) - for the third time or more. A unilateral process was noted in 81 (72%) patients, a bilateral process in 31 (28%). Comprehensive treatment is prescribed to all patients based on an individual approach. The subjective voice score on the visual analog scale averaged 6.4±1.7 points, 1 month after the start of treatment - 9.4±0.4 points. The recovery time was also determined individually, depending on the patient's profession and the requirements for voice quality.

Conclusions: 1. Vocal fold hemorrhage is caused by a disruption of the vascular wall integrity due to a sharp increase in subglottic pressure. 2. Predisposing factors for the development of vocal fold hemorrhage are dystrophic changes in the mucous membrane of the vocal folds and concomitant pathology that contribute to increased vascular permeability. 3. No correlation was found between the volume of vocal fold hemorrhage, its prevalence, and the time of its reduction and restoration of voice function. 4. The duration of treatment is determined individually and depends on the dynamics of the videolaryngostroboscopic picture and the indicators of acoustic voice analysis and the patient's requirements for voice quality. 5. In case of recurrent hemorrhages, examination of the patient is indicated to exclude coagulopathy; in the presence of concomitant pathology accompanied by microangiopathy (diabetes mellitus, chronic glomerulonephritis, dyshormonal disorders in women, etc.), consultation with specialists is necessary to assess the activity of the concomitant disease, the degree of its impact on the microcirculatory bed and, according to indications, correction of its therapy.