Vocal Fold Cyst - Types, Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Vocal folds are bands of soft tissue present in the larynx (voice box). These vocal folds vibrate, and the air from the lungs passes through the throat, nose, and nasal cavity, thus helping in producing the voice of the speech. Any cancerous or non-cancerous growths like polyps, nodules, or cysts can affect the ability of the vocal folds to perform normally thereby, causing dysfunction of speech, swallowing, and breathing. Vocal fold cysts are rare compared to vocal polyps and nodules. A vocal fold cyst can be unilateral or bilateral. Vocal fold cysts are very rare and range from four to seven percent of vocal cord lesions.

What Are the Types of Vocal Cord Cysts?

Two types of vocal fold cysts are as follows:

• Mucous Retention Cyst or Vocal Fold Retention Cyst: This is the most common type of vocal fold cyst that mostly occurs in cases of upper airway infections.

• Epidermoid Cyst: These cysts are very rare and are derived from fourth and fifth branchial arches or from healing injured mucosa.

What Are the Causes of Vocal Fold Cysts?

The exact cause of the vocal cord cyst is not known. Vocal fold cysts are supposed to be caused by various reasons:

• Upper respiratory tract infections.

• Excessive use of vocal cords/vocal abuse.

• Direct trauma to the vocal cords.

• Trauma to vocal folds during surgical procedures.

• Injury to the glans of the vocal fold due to repetitive trauma resulting in blockage or clogging of mucosal secretions from the gland.

• Smoking.

What Are the Signs and Symptoms of Vocal Fold Cyst?

Signs and symptoms related to vocal fold cyst are;

• Hoarseness of voice.

• Altered voice tone.

• Low-pitched voice.

• Pain in the neck.

• Vocal fatigue.

• Breathlessness while speaking.

• Slurring of speech.

• Loss of voice.

• More effort while speaking.

• Pain in the throat.

• A feeling of the presence of a foreign body in the throat.

• Clearing throat repetitively.

What Is the Pathophysiology of Vocal Fold Cyst?

Vocal overuse or misuse causes repeated trauma to the vocal folds and thus, leads to the development of vocal fold cysts, polyps, and nodules. The epidermoid cyst usually occurs from healing injured mucosa or congenital cell rests, and mucus retention cysts develop secondary to ductal obstruction. Additionally, trauma to contralateral cords by the cysts may also occur due to focal thickening. Dysphonia may also occur due to the benign lesions formed within the lamina propria due to close approximation to the vocal folds, and by disrupting the vibratory patterns.

How to Diagnose Vocal Fold Cyst?

Methods to diagnose vocal fold cysts are:

• Clinical Examination and History: The complete history of the patient, if undergone any surgery in the past, should be recorded. Any recent trauma with clinical signs and symptoms should be noted. A thorough clinical examination of the vocal cords and the voice changes are done.

• Laryngoscopy: An apparatus called a laryngoscope with a light on the tip is used to examine the vocal folds for the presence of any swellings and growth. Retention cysts of vocal folds are transparent and are easily seen in laryngoscopy. Epidermoid cystic swelling is difficult to visualize comparatively as it is mostly solid.

• Fiberoptic Endoscopy: Fiberoptic endoscopy of the larynx is performed to determine the size and the extent of the cystic swelling.

• Videostroboscopy: A telescope-like apparatus with a video camera is used to analyze the movements of the vocal fold as it vibrates. Any defect in the opening and closing of the vocal folds can be detected.

• Sound Analysis: Computerized analysis of sound is done by the speech pathologist to check for any abnormalities in the sound produced by the vocal fold.

• Computed Tomography (CT) Scan: This is done to check for the presence of any growth on the vocal folds.

What Are the Indications for Vocal Fold Cyst?

Treatment for vocal fold cysts is done by a multidisciplinary approach. The treatment options for vocal fold cyst without surgery and surgical treatment of vocal fold cyst are as follows:

• Drug Therapy: Anti-inflammatory drugs like steroids are used to reduce swelling.

• Voice Therapy: Voice therapy is given to the patient by a speech pathologist. In very rare cases, the vocal fold cyst gets resolved by this therapy. Mostly it needs surgical intervention to completely remove the cyst. Voice therapy after the surgery of a vocal cyst is recommended to prevent the recurrence of the cyst and improve the voice.

• Surgical Enucleation: A laryngoscope is used from the mouth to expose the vocal cords completely after the patient is kept under general anesthesia. Careful enucleation (clearing of cystic space) of the cystic lining with its contents is done surgically without damaging the adjacent laryngeal tissues. Post-treatment patients are kept on antibiotics, and voice therapy is given.

• Microsurgery: It is done under general anesthesia using tiny surgical instruments. An instrument is inserted from the mouth into the throat, and a small cut is given on the vocal cords to elevate the flap and visualize the cyst. The cyst is then removed without bursting it and without causing trauma to adjacent blood vessels. The flap closure is done adequately to avoid scarring. This procedure is also called phonomicrosurgery.

• Laser Surgery: It is done in an operating clinic or under general anesthesia. A laryngoscope is used to expose the vocal folds, and a laser is used to shrink the lesion and completely remove it.

Does the Vocal Fold Cyst Reoccur After Treatment?

Incomplete removal of the vocal cyst can lead to the recurrence of the cyst. So complete removal of the cystic contents along with its lining is recommended to prevent the recurrence.

Voice therapy and regular follow-up with the doctor after the surgical treatment reduce the risk of recurrence of vocal fold cysts.

How Can the Vocal Fold Cyst Be Prevented?

The vocal fold cyst can be prevented in the following ways:

• Avoid trigger factors like smoking.

• Avoid overuse of the vocal cords.

• Any underlying signs and symptoms like acid reflux disease, allergies, difficulty in swallowing, and breathing difficulties should be reported to the doctor immediately.

• An individual should drink plenty of fluids to stay hydrated.

Conclusion:

The cysts related to vocal folds are rare but can occur spontaneously and affect the voice, breathing, and swallowing, significantly affecting the quality of life. Any symptoms like change in the voice, pain in swallowing, and sensation of the presence of a foreign body in the throat should be noticed and reported to an otolaryngologist immediately. Various treatment modalities have been developed to treat vocal cord lesions efficiently like phonomicrosurgery and laser therapies. However, the early diagnosis of vocal fold cyst and treatment followed by post-surgical care like voice therapies are the keys to the successful outcome of the treatment and preventing the risk of the recurrence of vocal fold cyst.