Vocal fold varices and risk of hemorrhage.
To establish risk of hemorrhage in patients with varices compared to those without, determine additional risk factors, and make evidence-based treatment recommendations.



Retrospective cohort study.



Patients who were vocal performers presenting for care during a 24-month period were analyzed to determine incidence of hemorrhage. Patients with varices were compared to those without. Demographic information and examination findings (presence, location, character, and size of varices; presence of mucosal lesions or paresis) were analyzed to determine predictors of hemorrhage.



A total of 513 patients (60.4% female, mean age 36.6 years ± 13.95 years) were evaluated; 14 patients presenting with hemorrhage were excluded. One hundred and twelve (22.4%) patients had varices; 387 (77.6%) did not. The rate of hemorrhage in patients with varices was 2.68% at 12 months compared to 0.8% in patients without. Cox proportional hazard regression analysis revealed a hazard ratio of 10.1 for patients with varix developing hemorrhage compared to nonvarix patients (P < 0.0001). The incidence rate of hemorrhage was 3.3 cases per 1,000 person-months for varix patients compared to 0.5 cases per 1,000 person-months in the nonvarix group. There was no significant difference in the incidence of paresis, mucosal lesions, location of varix (left or right side; medial or lateral), or varix morphology (pinpoint, linear, lake) between patients who hemorrhaged and those that did not.



The presence of varices increases the risk of hemorrhage. Varix patients had 10 times the rate of hemorrhage compared to nonvarix patients, although the overall incidence is low. This data may be used to inform treatment of patients with varices.



4. Laryngoscope, 126:1163-1168, 2016.
New York Center for Voice and Swallowing Disorders, Weill Cornell Medical College, New York, New York, U.S.A.|Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A.
Christopher Guan-Zhong
CG
Tang
Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, U.S.A.
Gülce
G
Askin
Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, U.S.A.
Paul J
PJ
Christos
Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A.
Lucian
L
Sulica
D000328:Adult; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D009146:Music; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014648:Varicose Veins / Q000150:complications* / Q000453:epidemiology; D014827:Vocal Cords / Q000098:blood supply* / Q000473:pathology
Vocal fold hemorrhage; larynx; performing voice; phonotrauma; varix