Voice Disorders

Figure 2: An ovoid cyst on the upper surface of the vocal fold.

Figure 3: A small cyst on the vocal fold on the left of this picture would probably be overlooked if not examined with a stroboscope.

What is a cyst?

A cyst is a mass made up of a collection of material, usually mucus, that is surrounded by a membrane. It is found underneath the mucosa

, within the superficial lamina propria, the layer that is important for normal voice function. It is not entirely clear how cysts form, but many believe that they result from mucous glands that have become blocked. Sometimes, this happens spontaneously, but it seems likely that glands are more prone to become clogged when the vocal folds are irritated. Many cysts occur at the midpoint of the vocal fold, which suggests that phonotrauma, the physical stress resulting from voice use, may contribute to their formation.

Cysts are not precancerous or cancerous lesions. They are important purely because of their effect on the voice.

Figure 1: A large mid-vocal fold cyst. The white material is mucus
on the surface of the vocal folds.

Figure 2: An ovoid cyst on the upper surface of the vocal fold.

What are the symptoms of a cyst?

Cysts generally cause painless hoarseness. The hoarseness results from irregularities in vocal fold closure as well as irregularities in vibration, both the result of the bulk and location of the cyst. In some cases, the voice change may be accompanied by a sensation of a foreign body at the level of the vocal folds, or a feeling of wanting to clear the throat or cough.

What does a cyst look like?

A cyst is usually a spherical white or translucent mass located underneath the mucosa of the vocal fold. Because the mucosa drapes over it, it may look like a mound within the fold. For this reason, very small cysts may be indistinct. Examination by stroboscopy and under magnification is very helpful in clarifying the diagnosis.

Figure 3: Asmall cyst on the vocal fold on the left of this picture would
probably be overlooked if not examined with a stroboscope.
Figure 3: A small cyst on the vocal fold on the left of this picture would probably be overlooked if not examined with a stroboscope.

Usually, cysts occur singly. Although they may appear anywhere along the length of the vocal fold, a mid-fold location is most common.

How is a cyst treated?

Voice rest, often prescribed in cases of hoarseness, may improve the voice somewhat, but is not likely to make a cyst go away. Voice rest serves to soften and dissolve associated swelling, but the cyst itself will not usually shrink.

Very rarely, a cyst may resolve on its own. Probably the blockage that led to the accumulation of fluid resolves and the cyst drains. This generally happens only when a cyst has been present for a short while, and even under these circumstances, it is unusual.

Figure 4: Microscopic removal of a cyst.
Figure 4: Microscopic removal of a cyst.

                     Left: A cyst is visible under the mucosa.
                     Center: Once the overlying mucosa is opened, the cyst membrane
                     comes into view.
                     Right: The cyst is entirely removed, and the mucosa is draped
                     back into place.

Most commonly, a cyst must be removed surgically by means of microlaryngoscopic surgery. Because incomplete removal may lead to recurrence, every effort must be made to remove the cyst intact. At the same time, the overlying mucosa must be preserved and draped over the area where the cyst was removed to minimize the chance of scar. This type of surgery is technically challenging, since the cyst, which is usually fragile, may be attached to surrounding tissue and is likely to burst or leak if not handled very gently.

The physician must decide how much of a role chronic irritation and phonotrauma play in each individual patient and prescribe medication and voice therapy accordingly.

Cyst

Polyp

Reflux

Cancer

Tremor

Nodules

Papilloma

Laryngitis

Granuloma

Aging Voice

Hemorrhage

Sulcus Vocalis

Vocal Fold Scar

Reinke’s Edema

Vocal Fold Paralysis

Spasmodic Dysphonia

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