Vocal fold cysts (also known as vocal cord cysts) are benign masses of the membranous vocal folds. These cysts are enclosed, sac-like structures that are typically of a yellow or white colour. They occur unilaterally on the midpoint of the medial edge of the vocal folds. Practicing good vocal hygiene is recommended to prevent vocal fold cysts. Initial treatment of the cysts involves voice therapy to reduce harmful vocal behaviours. If symptoms remain after voice therapy, patients may require surgery to remove the cyst. Surgery is typically followed by vocal rest and further voice therapy to improve voice function. Cysts may also be treated using vocal fold steroid injection.
Types of vocal cord cysts
Sub-epithelial cysts (also known as mucous retention cysts) are closed lesions that occur from a build-up of tissue on the vocal folds.
Common symptoms include:
- Hoarse voice
- Inability to produce high pitch notes
- Fatigue when speaking
- Limited pitch range
- Pain near the larynx
- Variations in pitch when speaking Symptoms affecting quality of voice tend to worsen after speaking for long periods of time, or when speaking with increased volume.
Vocal dynamics
Vocal fold cysts cause the properties of the vocal folds to change. When a cyst is present on a vocal fold, the cover of the vocal fold becomes more stiff and increases in mass.
- They can be the result of phonotrauma.
Diagnosis
There are generally four components included in the full diagnosis of a vocal cord cyst: a medical and voice history, a head and neck exam, a perceptual assessment of the voice and imaging of the vocal folds. Imaging is most commonly done with laryngeal videostroboscopy. This procedure provides information about vocal fold vibrations during speech, vocal intensity and vocal frequency. (See section on Types of vocal cord cysts for more information.)
If the vocal fold cyst(s) are presumed to be congenital, the patient should have a history of presenting with a hoarse voice. Vocal fold cysts are most responsive when surgical intervention is supplemented with voice therapy. Applying vocal therapy techniques in isolation has not yet been proven to remediate and decrease the actual size of the vocal fold cyst.
Voice therapy to address harmful vocal behaviours is recommended as the first treatment option. If symptoms are significant, treatment usually involves microsurgery to remove the cyst. Congenital ductal cysts (those caused by blockage of a glandular duct) may be treated by marsupialization.
Following surgery, patients are recommended to take 2 to 14 days of vocal rest. Once adequate healing has occurred, the patient may be transitioned to relative vocal rest, which typically involves 5 to 10 minutes of breathy voicing per hour.
Professional voice users who do not experience substantial limitations due to their cysts may choose to forego surgery. Injection of the vocal folds may be done transorally or percutaneously, through the thyrohyoid membrane, thyroid cartilage, or cricothyroid membrane.