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  • Acute Vocal Fold Haemorrhage Bleeding in the vocal fold can occur spontaneously, following phonotrauma, or iatrogenically following surgery of procedures involving the larynx or tracheobronchial tree. Usually, the blood collects in the superficial layers of the true vocal fold. Deeper layers involvement (beyond the vocal ligament) can also occur but rare. The amount of blood collection (haematoma) is usually small being limited by the epithelium and attachments of the ligaments. The effects ranges from hoarseness of voice, reduction in vocal range, or even fatigue. A period of absolute followed by limited voice rest is essential to allow normal healing and prevent potential scarring. A short course of steroid is indicated if pronounced inflammation and edema present. This video clip shows an acute subepithelial haemorrhage involving the right true vocal fold in a teacher after an episode intensive voice use. It resolved completely after a short period of dedicated voice rest.