Vocal-fold cyst

Vocal fold 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 usually form unilaterally on the midpoint of the medial edge of the vocal folds. However, they can form on the cephalic, or upper/superior, surface of the vocal folds as well. There are two types of vocal fold cysts that differ in terms of location:

The symptoms of vocal fold cysts vary but commonly include a hoarse voice and problems with the pitch of the voice. Initial treatment of the cysts involves voice therapy to reduce harmful vocal behaviours. If symptoms remain, patients may require surgery to remove the cyst. Surgery is typically followed by vocal rest and further voice therapy to restore voice function. Cysts may also be treated using vocal fold steroid injection.

There are several causes of vocal fold cysts:

Both sub-epithelial vocal fold cysts and ligament vocal fold cysts involve similar symptoms. The presence and the severity of symptoms may be influenced by the location and size of the cyst. Common symptoms include:

The accompanying signs and symptoms of vocal fold cysts may remain stable or increase over time. In rare cases, symptoms actually improve. Symptoms affecting the quality of the voice tend to worsen after speaking for long periods of time and when speaking with increased volume. Many individuals who use their voice professionally will find even the presence of slight symptoms to be problematic. However, some voice professionals are not impacted by the presence of vocal cysts.

Mucous retention cysts are most commonly seen in individuals that endure high vocal stress in their daily lives, while epidermoid cysts are usually congenital or second to vocal trauma (see lead section for more information on different types of cysts). The two types of vocal fold cysts can be differentiated from other vocal fold growths in several ways. Both types show decreased amplitude of vibrations and reduced or absent mucosal wave. Mucous retention cysts show a translucent mass of mucous usually below the free margin of the glottis, while epidermoid cysts are yellow masses under the first epithelial layer of the vocal folds. Epidermoid cysts generally appear in the superior and medial regions of the midmusculomembranous region of the folds, as opposed to mucous cysts appearing in the inferior region. Vocal fold cysts are differentiated from other vocal fold masses in that they are unilateral and subepithelial.

Four components to a full diagnosis are: medical and voice history, head and neck exam, then perceptual assessment of voice and imaging of vocal folds. The primary perceptual sign of vocal fold cysts is hoarseness of the voice. However, diagnosis is difficult; in most cases, when a diagnosis cannot first be reached via behavioural assessment and intervention, the patient undergoes an imaging procedure. Imaging is most commonly done with laryngeal videostroboscopy. This procedure provides information about vocal fold vibrations during speech, vocal intensity and vocal frequency. Imaging shows the reduced movement of the vocal folds (mucosal wave) when a vocal fold cyst is present.

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