What are vocal cord cysts?

A vocal cord cyst (sometimes referred to as a “vocal fold” cyst by physicians) is a localized inflammation or a fluid-filled sac on the vocal cords.  

Signs and symptoms

The symptoms of a vocal cord cyst include hoarseness, straining, pitch limitations and sometimes pain when trying to speak or sing. Laryngopharyngeal Reflux (LPR) can worsen symptoms.

Cause

Vocal cord cysts can develop in several ways:

• In utero, while a baby’s vocal cords are developing
• From abuse or misuse of the voice (including straining, yelling and frequent singing)
• Mucous becomes trapped in the glands in the voice box (similar to a pimple)

Testing and diagnosis

The diagnosis of vocal cord cysts is made by laryngoscopy or stroboscopy, tests that examine the voice box.

• Laryngoscopy: A doctor will place a spaghetti-like camera in your child’s nose and down the throat. This allows our team to look at your child’s voice box, or larynx.
• Stroboscopy: A small, thin, flexible endoscope with a camera is gently inserted through the nose to the area in the back of the throat above the vocal cords. The study evaluates the motion of your child’s vocal cords when there are concerns regarding the strength, pitch and quality of his voice. If there is decreased vibration (stiffness) and a lesion is seen on the vocal cord, it is suggestive of a cyst.

Most of the time, these exams can be done while your child is awake and in an office setting.

Occasionally, when not obviously noted in the office, cysts may be diagnosed by microlaryngoscopy and/or a vocal cord palpating tool while under anesthesia in the operating room.

Treatment

Vocal cord cysts are usually treated by complete surgical excision. Unlike vocal cord nodules, vocal cord cysts will not go away with conservative methods (such as voice therapy) but the voice can be improved somewhat using these methods, delaying the need for surgery.

Medical management of possible reflux and allergies, as well as proper use of the voice are important as they can reduce reactive damage to the opposite vocal fold, and may help prevent future lesions by minimizing voice abuse.

Outlook

When a vocal cord cyst is completely removed, the outlook is good, as long as the voice is cared for with voice therapy and proper use of the voice. Scarring from surgical removal of the cyst is a risk, and while unusual, it can cause persistent voice problems.

There is a risk of cysts rupturing on their own if they are not removed, which can also lead to scarring.

Follow-up care

If voice therapy is recommended, the initial follow-up will be about three months after beginning the therapy in order to assess progress and response. If reflux management is recommended, then a three-month follow-up in clinic may be recommended as well. If there is no response to voice therapy and/or medical therapy, then a surgical intervention may be recommended. The follow-up after surgery will include voice therapy with your child’s speech pathologist, return to clinic about one month post-surgery and then about three months, six months and 12 months later.

Why choose CHOP?

Our voice team at The Children’s Hospital of Philadelphia is a dynamic multidisciplinary group of professionals with years of experience managing pediatric voice difficulties.