Vocal fold hemorrhage associated with coumadin therapy in an opera singer

Vocal fold hemorrhage can represent a disastrous and potentially career end ing injury to a singer or professional voice user. The risk factors of voca l fold hemorrhage, including laryngeal trauma, phonotrauma, aspirin and non steroidal antiinflammatories, and hormonal imbalances are well known. We pr esent a case of an opera singer who developed recurrent vocal fold hemorrha ge associated with coumadin anticoagulation therapy. This case highlights t he importance of the risk of vocal fold hemorrhage to professional singers and professional voice users and offers an alternative to long-term coumadi n therapy in this select population.