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assist in diagnosis. The primary perceptual sign of vocal fold cysts is hoarseness of the voice. Diagnosis through perceptual means alone is difficult, therefore in the fourth component of diagnosis the patient often undergoes an imaging procedure. Imaging is most commonly done with laryngeal videostroboscopy. A videostroboscopy is an examination of the vocal folds using flashes of light to slow down the image of the vocal fold movement enough to provide a sharp picture of the phases of the movement cycle (mucosal wave.) 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. Further, videostroboscopy tends to show increased submucosal swelling in the affected areas of the vocal fold(s) More recently, other technologies have been introduced to assist with obtaining imaging of the vocal folds, including the use of
101:
124:) are closed lesions that occur from a build-up of tissue on the vocal folds. They are typically found in the middle portion of the upper lamina propria of the vocal folds. Sub-epithelial cysts are small and white in colour. Their presence on the vocal folds usually does not disrupt the vibration of the vocal folds for speech (known as the "mucosal wave").
40:
134:) are closed lesions that occur near the vocal ligament in the deep layers of the lamina propria. Ligament cysts are usually larger in size than sub-epithelial cysts. They are yellow in colour and unlike sub-epithelial cysts, their presence is usually observed to disrupt the mucosal wave of the vocal folds in the region around the cyst.
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resulting in repeated collisions of the right and left vocal folds. Phonotrauma subjects the vocal folds to excessive mechanical forces during these vibratory cycles, which can lead to the development of a wound. It is the healing of these wounds, which leads to tissue re-structuring, that can result
82:
The symptoms of vocal fold cysts vary but most commonly include a hoarse voice and problems with the pitch of the voice. Vocal fold cysts are diagnosed based on gathering a case history, perceptual examination, and laryngeal imaging. Practicing good vocal hygiene is recommended to prevent vocal fold
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Voice therapy to address harmful vocal behaviours is recommended as the first treatment option. Voice therapy may involve reducing tension in the larynx, reducing loudness, reducing the amount of speech produced, and modifying the environment. If symptoms are significant, treatment usually involves
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Professional voice users who do not experience substantial limitations due to their cysts may choose to forego surgery. Considering that some cysts remain stable over long periods of time, voice therapy alone may be an option for those who are resistant to surgery. Another option for those who are
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During surgery, attempts are made to preserve as much vocal fold tissue as possible, given that glottal insufficiency (a gap in the vocal folds) is a possible consequence of surgery. Vocal fold tissue can be preserved during surgery by raising a micro-flap, removing the cyst, then laying the flap
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Signs and symptoms of vocal fold cysts may remain stable or increase over time. In rare cases it is also possible for symptoms to improve if the cyst ruptures spontaneously. Symptoms affecting quality of voice tend to worsen after speaking for long periods of time, or when speaking with increased
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They can be the result of phonotrauma. Phonotrauma refers to behaviours that can lead to vocal fold injuries, such as vocal overuse (i.e. too much speaking), vocal misuse (i.e. speaking in an unnaturally high or low pitch), or vocal abuse (i.e. yelling or whispering for prolonged periods). Vocal
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or vascular changes of the vocal folds following surgery. In severe cases, these resulting symptoms may require further surgery. The patient must always be aware of the impact and potential complications of surgery on their voice, especially if the voice is heavily used occupationally. In these
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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. A medical and voice history can help distinguish patterns of misuse and phonotrauma to
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The vocal folds consist of 3 primary layers; the
Epithelium, the Lamina Propria (containing superficial, intermediate and deep layers) and the Thyroarytenoid Muscle. Vocal fold cysts commonly appear in the Superficial portion of the Lamina Propria, the cyst size impacts the nature of this layer
261:
Vocal fold cysts can be differentiated from other vocal fold growths as they are usually unilateral. The two types of vocal fold cysts (sub-epithelial and ligament cysts) can be differentiated by colour, size and location. (See section on Types of vocal cord cysts for more information.)
67:. 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. They can also form on the upper/superior, surface of the vocal folds. There are two types of vocal fold cysts:
452:
Patients with sub-epithelial cysts have a better prognosis for timely recovery of vocal abilities than patients with ligament vocal fold cysts. Typically, patients can resume speaking activities in 7–30 days following surgery, and singing activities 30–90 days post-surgery.
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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
408:. In absolute vocal rest, activities such as talking, whispering, whistling, straining, coughing, and sneezing are restricted. Once adequate healing has occurred, the patient may be transitioned to relative vocal rest, which typically involves 5 to 10 minutes of
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making it more rigid. The border of vocal fold cysts contains squamous or epithelial cells. In the case of retention cysts, the border consists of glandular epithelium. Epidermoid cysts closely resemble epidermal cysts that can occur anywhere in the body.
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to remove the cyst. Although voice therapy is useful for preventing vocal fold cysts caused by phonotrauma and for promoting safe vocal practices, vocal fold cysts tend not to respond to therapy alone and typically require surgery for full repair.
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approach. 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.
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per hour. Voice therapy is then required to restore as much function as possible. Post-operative voice therapy may include addressing harmful vocal behaviours, exercises to restrengthen the larynx, and reintegration into normal voice activities.
258:(NBI.) Narrow-band imaging involves the use of blue and yellow lights to improve the picture quality of an image and accentuate blood vessel visibility. NBI has been found to help improve visual identification of vocal fold cysts in some cases.
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In addition, good vocal hygiene involves getting enough rest and drinking sufficient water. It is important to keep the vocal fold tissue healthy and hydrated, and when possible to limit the quantity of speaking in order to avoid damage.
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back down. This is intended to lead to minimal scarring and improved voice function. However, if any epithelium from the cyst sac is left behind during surgery, the cyst may regrow. Surgery of the larynx may also be conducted using a
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A key aspect of preventing vocal fold cysts is good vocal hygiene. Good vocal hygiene promotes the healthy use of the vocal apparatus and the avoidance of phonotrauma. Good vocal hygiene practices involve the avoidance of:
433:. After VFSI, patients are recommended to take 1 to 7 days of vocal rest. VFSI may also be used to delay surgery, or as a treatment method when the risks associated with surgery are deemed to be too high.
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volume. Many individuals who use their voice professionally find even a slight presence of symptoms to be problematic. However, some voice professionals are not impacted by the presence of vocal cysts.
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Sub-epithelial vocal fold cysts and ligament vocal fold cysts are characterized by similar symptoms. The presence and severity of symptoms may be influenced by the location and size of the cyst.
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Following diagnosis, voice therapy should be implemented to optimize vocal hygiene. Vocal fold cysts tend not to improve solely through vocal rest or vocal therapy.
893:
1199:
Ogawa; Inohara, Makoto; Hidenori (Fall 2018). "Is voice therapy effective for the treatment of dysphonic patients with benign vocal fold lesions?".
1244:
Benninger, Michael S. (2000). "Microdissection or
Microspot CO2 Laser for Limited Vocal Fold Benign Lesions: A Prospective Randomized Trial".
1342:
1184:
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1094:"GMS | GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery | Diagnostic and therapeutic pitfalls in benign vocal fold diseases"
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They can result from the blockage of a mucous gland's excretory duct. In this case, they are sometimes referred to as retention cysts.
397:, which was reported as early as the 1970s. Congenital ductal cysts (those caused by blockage of a glandular duct) may be treated by
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becomes more stiff and increases in mass. The increased mass and stiffness tends to result in hyperkinetic muscular movement during
1049:. Casper, Janina K.,, Leonard, Rebecca (Fourth ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
698:. Casper, Janina K.,, Leonard, Rebecca (Fourth ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
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unwilling to undergo surgery is vocal fold steroid injection (VFSI). Injection of the vocal folds may be done transorally or
208:. (see Signs and Symptoms) Specifically, the presence of a vocal fold cyst leads to an asynchronous mucosal wave of the
944:
Johns, Michael M (2003). "Update on the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts".
910:
Reiter, Rudolf; Hoffman, Thomas Karl; Pickhard, Anja; Brosche, Sibylle (2015). "Hoarseness - Causes and
Treatment".
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If the vocal fold cyst(s) are presumed to be congenital, the patient should have a history of presenting with a
100:
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864:. Rubin, John S. (John Stephen),, Sataloff, Robert Thayer,, Korovin, Gwen S. (Fourth ed.). San Diego, CA.
352:
595:
Franco, Ramon A.; Andrus, Jennifer G. (2007). "Common
Diagnoses and Treatments in Professional Voice Users".
78:
Ligament vocal fold cysts- located within the deeper layers of the lamina propria or on the vocal ligament.
1392:"Intralesional steroid injection for benign vocal fold disorders: A systematic review and meta-analysis"
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Ballif, Catherine L.; Gorman, Stephen; Kelchner, Lisa N.; LeBorgne, Wendy D.; Rettig, Jennifer R.
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Ahmad, Sidrah M.; Soliman, Ahmed M.S. (February 2007). "Congenital
Anomalies of the Larynx".
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Understanding voice problems : a physiological perspective for diagnosis and treatment
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Understanding voice problems : a physiological perspective for diagnosis and treatment
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Naunheim, Matthew R.; Carroll, Thomas L. (December 2017). "Benign vocal fold lesions".
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Understanding Voice
Problems: A Physiological Perspective for Diagnosis and Treatment
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ENT Board Prep: High Yield Review for the
Otolaryngology In-service and Board Exams
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Patients with vocal fold cysts are considered for surgery when presenting with:
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200:. Hyperkinetic movement is characterized by increased rigidity in the affected
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Wang, Chi-Te; Liao, Li-Jen; Cheng, Po-Wen; Lo, Wu-Chia; Lai, Mei-Shu (2013).
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204:. This hyperkinetic movement results in the voice being perceived as
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Rubin, John S.; Sataloff, Robert T.; Korovin, Gwen S. (2014-05-01).
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Following surgery, patients are recommended to take 2 to 14 days of
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a) Vocal fold cysts b) Vocal fold cysts with corresponding scars c)
754:"Diagnostic and therapeutic pitfalls in benign vocal fold diseases"
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Colton, Raymond H.; Casper, Janina K.; Leonard, Rebecca (2006).
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665:. Skoulakis C., Kountakis S. Cham, Switzerland: Springer, Cham.
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Calhoun, Karen H.; Wax, Mark K.; Ebling, David E., eds. (2001).
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A cross section of the vocal folds showing the different layers.
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355:, or any substance that alters perception (i.e. sleeping pills)
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Verdolini, Katherine; Rosen, Clark A; Branski, Ryan C (2005).
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Current Opinion in Otolaryngology & Head and Neck Surgery
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Current Opinion in Otolaryngology & Head and Neck Surgery
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Sub-epithelial vocal fold cysts- located in the superficial
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1154:. Boca Raton, FL: CRC Press, Taylor & Francis Group.
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There are several possible causes of vocal fold cysts:
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Vocal Cord / Voice Disorder Community - Online Support
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Speaking in an unnatural voice (i.e. too high or low)
461:cases, post-operative therapy should be discussed.
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Vocal Fold Cyst and mucosal bridge after dissection
32:
1223:. Baltimore: Lippincott Williams & Wilkins.
806:Altman, Kenneth W. (2007). "Vocal Fold Masses".
301:Frequently of talking over loud background noise
647:(1st ed.). American College of Physicians.
83:cysts. Initial treatment of the cysts involves
1150:Costello, Declan; Sandhu, Guri, eds. (2016).
298:Whispering loudly or for long periods of time
184:Vocal fold cysts cause the properties of the
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1077:: CS1 maint: multiple names: authors list (
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1175:Lin, Fred Y.; Patel, Zara M., eds. (2014).
519:Classification manual for voice disorders-I
892:: CS1 maint: location missing publisher (
862:Diagnosis and treatment of voice disorders
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1360:"Postsurgical Vocal Rest Recommendations"
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281:Lack of improvement through voice therapy
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597:Otolaryngologic Clinics of North America
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958:10.1097/00020840-200312000-00009
307:Continual clearing of the throat
661:Petros, Koltsidopoulos (2017).
1459:Photo Library at VoiceInfo.org
1207:: 661–666 – via ScienceDirect.
645:Expert guide to otolaryngology
1:
1045:H., Colton, Raymond (2011).
1008:10.1097/moo.0000000000000408
694:H., Colton, Raymond (2011).
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1179:. New York, NY: Springer.
152:Inability to produce high
1333:Myers, Eugene N. (2008).
1309:10.1016/j.otc.2006.10.004
820:10.1016/j.otc.2007.05.011
663:ENT : core knowledge
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353:tricyclic antidepressants
145:Common symptoms include:
113:Types of vocal cord cysts
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752:Bohlender, Jörg (2013).
313:Talking with a cold or
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122:mucous retention cysts
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1152:Practical Laryngology
1092:J, Bohlender (2013).
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431:cricothyroid membrane
304:Talking while yawning
244:in a vocal fold cyst.
239:folds vibrate during
159:Fatigue when speaking
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557:. Berlin: Springer.
118:Sub-epithelial cysts
521:. Psychology Press.
423:thyrohyoid membrane
329:The consumption of
256:Narrow-band imaging
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162:Limited pitch range
75:of the vocal folds.
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1201:Auris Nasus Larynx
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138:Signs and symptoms
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471:Vocal fold nodule
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