August 24, 2015

Donny Osmond Undergoes Vocal Cord Surgery

On August 11, 2015, Donny Osmond underwent vocal cord surgery to remove a hemorrhagic polyp.  The year 2015 is turning out to be a doozy for injured vocal cords with 4 other celebrity singers being sidelined for vocal cord injuries.

Miranda Lambert - July 2015
• Meghan Trainor - July 2015
• Chad Kroeger - June 2015
• Sam Smith - April 2015
• Nathan Sykes - April 2013
• Nicki Manaj - August 2012
• Florence Welch - July 2012
• Maxwell - June 2012
• Keith Urban - Nov 2011
• Adele - Oct 2011
• John Mayer - September 2011
• Scott Weiland - September 2011

In any case, this unfortunate news about Donny Osmond was shared on Facebook.

Normally, the vocal cords are pearly white without any bump on it. Watch a video of how this exam is performed.

However, with aggressive voice use, the vocal cords can become inflamed and potentially lead to bump formation like a hemorrhagic polyp. With a bump on the vocal cord, the voice can become raspy and irregular.

Typically in this scenario, the voice is better in the morning and worse by the end of day with voice use.

When there is a hemorrhagic polyp as in Donny Osmond's case, the vocal cords may have looked like this where the blue arrowhead is pointing to a hemorrhagic polyp. The green arrow is pointing towards a feeding blood vessel.

The issue with a blood vessel within the vocal cord itself is that it fluctuates in size due to whether it is irritated from phono-trauma or even hormones. When a polyp is present, the vocal changes are even more dramatic. Such fluctuation in size causes the voice to change in pitch and quality on an hour to hour basis depending on how much swelling occurs. For a singer, it makes the voice very unpredictable.

When the blood vessel becomes engorged and traumatized, it may even rupture leading to a vocal cord hemorrhage. 

This is a dangerous situation for a singer because of their regular voice use and need to use it forcefully. However with too much force, the blood vessel may suddenly rupture (even in the middle of a performance) resulting in a hemorrhage into the vocal lining itself causing a sudden and complete loss of voice. There may even be mild pain associated with this occurrence.

To the right is a picture of a vocal cord hemorrhage. Note the entire vocal cord on one side (which is the patient's right side for those in the know) is brilliant red indicative of the presence of blood throughout the cord.

How is this treated?

For Donny Osmond, it seems that he underwent a procedure called micro-direct laryngoscopy with excision of the hemorrhagic polyp given the strict 3 weeks of voice rest he is now on after surgery.

Watch a video on this approach (video shows a generic vocal cord mass removal, but the approach is identical).

The other option that is often employed is use of a laser first to extinguish blood vessels present which may also significantly resolve the polyp followed by excision of the residual polyp at a later date. The laser may resolve the polyp to the point that surgical excision may not even be needed. The laser is relatively non-invasive and I feel the risk of scarring to be less compared with surgical excision. Furthermore, a smaller polyp that is ultimately excised also means a smaller wound that needs to heal.

Shown at end of this blog article is a video of a vascular polyp being obliterated using a pulsed-dye laser (courtesy of Dr. Chandra Marie-Ivey). Another type of laser that may be used is a KTP laser. Read more about laser treatment of vocal cord pathology here.

Regardless of how or in what order the surgery is performed, strict voice rest is mandatory for a period of time post-operatively. For Donny Osmond, 3 weeks has been reported. For Adele who also suffered from a hemorrhagic polyp that required voice rest after surgery, it lasted nearly two months (Nov and Dec 2011). Voice rest is necessary because with talking or any other vocal activity, the vocal cords come together. After surgical removal of a polyp, there is a raw surface present which won't heal as well if the other vocal cord is banging against it. Talking after vocal cord surgery is analogous to jogging right after foot surgery.

The vocal cord surgical wound MUST heal prior to talking let alone singing for normal recovery. That means strict voice rest. Strict voice rest means no talking, no singing, no whispering, no mouthing words, no throat-clearing, no humming, etc.

Read more about vocal cord polyps here.

Watch a video of how vocal cord surgery is performed here!

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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