Overview
Submucosal hemorrhage of the vocal cord refers to bleeding occurring beneath the mucosal layer of the vocal folds, often requiring endoscopic intervention for diagnosis and management 1.Diagnosis
Endoscopic visualization to identify the source of bleeding 1.
Laryngoscopy under sedation may be necessary for detailed assessment 1.
Imaging (e.g., CT, MRI) may be considered if the extent of bleeding or underlying causes are unclear 1.Management
First-line treatments:
- Endoscopic techniques such as cautery or sclerotherapy to control bleeding 1.
Adjunctive treatments:
- Maintenance of oxygenation, potentially using high-flow nasal cannula (HFNC) to ensure adequate SpO2 levels during sedation 1.Special Populations
Elderly: Careful monitoring of oxygenation and sedation depth is crucial due to potential comorbidities and altered physiological responses 1.
Comorbidities: Patients with significant comorbidities may require tailored sedation protocols and closer monitoring of respiratory parameters 1.Key Recommendations
Utilize high-flow nasal cannula (HFNC) over conventional nasal cannula during sedation for endoscopic procedures to maintain higher oxygen saturation levels (Evidence: Moderate) 1.
Employ endoscopic techniques such as cautery or sclerotherapy as primary interventions for controlling submucosal hemorrhage of the vocal cord (Evidence: Expert opinion) 1.
Tailor sedation and monitoring protocols based on patient-specific factors, particularly in elderly patients or those with significant comorbidities (Evidence: Expert opinion) 1.References
1 Lee S, Choi JW, Chung IS, Kim TJ, Sim WS, Park S et al.. Comparison of high-flow nasal cannula and conventional nasal cannula during deep sedation for endoscopic submucosal dissection: a randomized controlled trial. Journal of anesthesia 2024. link