page_title: Vocal cord cyst
section_title: Treatment
hierarchical_section_title: Vocal cord cyst / Treatment
caption_attribution_description: English: Vocal fold cysts after surgery
context_page_description: 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 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:
  Sub-epithelial vocal fold cysts- located in the superficial lamina propria of the vocal folds.
  Ligament vocal fold cysts- located within the deeper layers of the lamina propria or on the vocal ligament.
  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 cysts. Initial treatment of the cysts involves voice therapy 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 steroid injection.
context_section_description: Vocal fold cysts are treated using a multidisciplinary 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.
  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 microsurgery 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.
  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 microflap, removing the cyst, then laying the flap 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 CO₂ laser, which was reported as early as the 1970s. Congenital ductal cysts (those caused by blockage of a glandular duct) may be treated by marsupialization.
  Following surgery, patients are recommended to take 2 to 14 days of vocal rest. 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 breathy voicing 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.
  
  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 unwilling to undergo surgery is vocal fold steroid injection (VFSI). Injection of the vocal folds may be done transorally or percutaneously, through the thyrohyoid membrane, thyroid cartilage, or cricothyroid membrane. 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.
caption: Vocal Fold Cyst and mucosal bridge after dissection
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