Congenital and Acquired Cysts
Intracordal Cyst
Cysts are fluid-filled, sessile (blister-like) growths that can be present congenitally (from birth) or be acquired later in life. Unlike some of the other vocal pathologies, there are no clear factors that are documented to cause cysts. These little sacs may occur anywhere in the membranous portion of the true vocal fold, in the laryngeal ventricle, or in the ventricular folds. Vocal fold cysts are usually the result of a blocked mucosa gland duct, similar to a sty you would get in your eye. They appear as a whitish oval form, sometimes transparent. Although cysts usually occur unilaterally (on one side), bilateral (both sides) cysts may be present. If the cyst occurs in such a place on the vocal folds that it irritates the opposite vocal fold, the resultant tissue changes may give the erroneous appearance of two lesions. It sometimes occurs that a vocal fold cyst on one side may be easily misdiagnosed as bilateral vocal fold nodules.
Cysts create a very stiff adynamic (non-vibrating) segment that is visible during stroboscopic imaging. Stroboscopic observation of vocal fold vibration is often very helpful to detect the increase in mass and stiffness of the vocal fold cover to differentiate cysts from nodules. The cyst size and severity will influence how much a person’s voice is effected, from mild to moderate dysphonias to near-aphonia in the case of large cysts. Because of the predominant stiffness characteristics posed by these lesions, even a very small cyst may have a significant negative effect on the singing voice. Cysts do not respond to behavioral voice therapy. The typical treatment is surgical removal with post-operative rehabilitative voice therapy to assist in recovery.