Vocal-fold cyst

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Vocal folding cyst is a benign mass of the membranous vocal band. This cyst is closed, a structure like a sac that is usually yellow or white. They are usually formed unilaterally at the midpoint of the medial edges of the vocal cords. However, they can form on the cephalic surface, or upper/superior, from the vocal folds as well. There are two different types of vocal folding cysts in terms of location:

1. Sub-epithelial vein cyst located in the superficial lamina propria of the vocal fold.
2. Ligament band bending cysts located within deeper lamina propria layers or on vocal ligaments.

The symptoms of vocal folding cysts vary but usually include hoarseness and problems with tone of voice. Early treatment of cysts involves sound therapy to reduce harmful vocal behavior. If symptoms persist, the patient may require surgery to remove the cyst. Surgery is usually followed by a vocal break and further sound therapy to restore the sound function. Cysts can also be treated using vocal fold steroid injections.

Video Vocal-fold cyst

Signs and Symptoms

Both sub-epithelial vein folding cysts and ligament band folding cysts involve similar symptoms. The presence and severity of symptoms can be affected by the location and size of the cyst. Common symptoms include:

• Hoarse voice
• Inability to generate high pitch notes
• Fatigue while talking
• Unlimited tone range
• Pain near the larynx
• Variations of pitch when talking

The signs and symptoms that accompany the vocal folding cyst may remain stable or increase over time. In rare cases, symptoms actually improve. Symptoms that affect sound quality tend to worsen after talking for long periods of time and when talking to an increased volume. Many people who use their voices professionally will find even the presence of minor symptoms becomes problematic. However, some sound professionals are not affected by the presence of vocal cysts.

Maps Vocal-fold cyst

Cause

There are several causes of vocal folding cysts:

1. They can be innate.
2. Can occur due to blockage of excretion of mucus gland excretion. In this case, they are sometimes referred to as retention cysts.
3. They can be the result of phonotrauma. Phonotrauma refers to behaviors that can cause vocal folds injuries, such as excessive vocals (ie too much talking), vocal abuse (ie speaking in an unnatural high or low tone), or vocal abuse (ie screaming or whispering for a long time). The vocal folds vibrate during the phonation resulting in repeated collisions on the folds of the right and left vowels. Phonotrauma subjugates the vocal cords to excessive mechanical strength during this vibration cycle, which can lead to the development of wounds. This is the healing of these injuries, which leads to tissue rearrangement, which can produce vocal folding cysts.

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Diagnosis

Mucus retention cysts are most commonly seen in individuals who experience high vocal stress in their daily lives, while epidermoid cysts are usually congenital or second for vocal trauma (see lead for more information on different types of cysts). Two types of vocal folding cysts can be distinguished from the growth of other vocal folds in several ways. Both types show decreased amplitude of vibration and decrease or loss of mucosal waves. Mucus retention cysts show a translucent mucosal mass usually below the glottis free margin, while epidermoid cysts are a yellow mass below the first epithelial layer of the vocal cords. Epidermoid cysts commonly appear in the superior and medial regions of the midmusculomembran region of the folds, as opposed to mucosal cysts appearing in the inferior region. Vocal folding cysts are distinguished from the mass of other vocal folds because they are unilateral and subepithelial.

The four components for a complete diagnosis are: medical and sound history, head and neck examination, then assessment of voice perception and vocal cord imaging. The main perceptual sign of a vocal folding cyst is a hoarse voice. However, diagnosis is difficult; in many cases, when the diagnosis can not be achieved through behavioral assessment and intervention, the patient undergoes the imaging procedure. Imaging is most often done with laryngeal videostroboscopy. This procedure provides information about the vibrations of the vocal cords during speech, vocal intensity and vocal frequency. Imaging shows a decrease in vocal cord motion (wave mucosa) when there is a vocal folding cyst.

Patients with vocal folding cysts are considered for presentation surgery by:

• Disfonia
• Lack of improvement through sound therapy

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Prevention

The key aspect of preventing vocal folding cysts is good vocal hygiene. Good vocal hygiene promotes the use of healthy vocal apparatus and avoids phonotrauma. Good vocal hygiene practices involve avoidance:

• Yelling
• Whisper loud or for long periods
• Many speak in loud backgrounds
• Talking while yawning
• Continuous throat cleansing
• Speaks with an unnatural sound (ie too high or low)
• Talk to a cold or laryngitis
• Smoking tobacco or cannabis
• Consumption of alcohol and coffee
• Use of antihistamines, aspirin, steroids, tricyclic antidepressants, or any substance that alters perceptions (ie sleeping pills)
• Rotten air

In addition, good vocal hygiene involves adequate rest and drink plenty of water. It is important to keep the vocal cord tissue healthy and hydrated, and when possible to limit the quantity of speech to avoid damage.

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Treatment

Vocal folding cysts are treated using a multidisciplinary approach. Sound therapy for treating hazardous vocal behaviors is recommended as the first treatment option. Sound therapy may involve reducing tension in the larynx, reducing loudness, decreasing the amount of speech produced, and modifying the environment. If the symptoms are significant, treatment usually involves microsurgical surgery to remove the cyst.

During surgery, efforts are made to maintain as much of the vocal folding tissues as the glottic insufficiency (gap in the vocal cords) is a possible consequence of surgery. The tissue of the vocal fold can be maintained during surgery by lifting the microflap, lifting the cyst, then putting the flap back down. It is intended to cause minimal scarring and improve sound function. However, if there is an epithelium of a cyst left during surgery, the cyst may regrow. Laryngeal surgery can also be done using a CO ₂ laser, which was reported in the early 1970s. Congenital duct cysts (caused by glandular blockage) can be treated with marsupialisation.

After surgery, the patient is advised to rest for 2 to 14 days. In an absolute vowel break, activities such as talking, whispering, whistling, chanting, coughing, and sneezing are restricted. After adequate healing has occurred, the patient can be diverted to a relative vocal break, which usually involves 5 to 10 minutes of vaporizing sound every hour. Sound therapy is then required to restore function as much as possible. Post-operative sound therapy may include overcoming dangerous vocal behavior, exercises to re-enforce the larynx, and reintegration into normal voice activity.

Professional voice users who do not experience substantial limitations because their cysts can choose not to perform the operation. Considering that some cysts remain stable for long periods of time, sound therapy alone may be an option for those who are resistant to surgery. Another option for those who do not want to undergo surgery is vocal fold steroid injection (VFSI). Vocal cord injection may be performed transversely or percutaneously, via a thyrohyoid membrane, thyroid cartilage, or cricothyroid membrane. After VFSI, patients are advised to rest for 1 to 7 days. VFSI may also be used to delay surgery, or as a method of treatment when the risks associated with surgery are considered too high.

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Prognosis

After diagnosis, sound therapy should be implemented to optimize vocal hygiene. However, vocal folding cysts usually do not improve only with vocal breaks or vocal therapy. In contrast, a surgical procedure using a microflap approach is performed to remove the cyst (see Treatment).

After surgery, patients are advised to rest their voices for a week with a gradual re-introduction of voice use with speech language pathologists after this break period. This early rest period can vary between 2 and 14 days. Patients with subepithelial cysts have a better prognosis for the recovery of vocal abilities in a timely manner than patients with ligaments bending cysts. Usually, the patient can resume speaking activities within 7-30 days after surgery, and 30-90 post-operative singing activities.

Up to 20% of patients show scarring, polyps or vascular changes in the vocal cords after surgery. In severe cases, these resulting symptoms may require further surgery. Patients should always be aware of the impact and potential complications of surgery on their voices, especially if the sound is widely used in the workplace. In this case, postoperative therapy should be discussed.

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See also

• Vocal fold nodules

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References

src: medicine.uiowa.edu

External links

• Community Voice/Voice Cable - Online Support
• VoiceInfo.org
• Photo Library in VoiceInfo.org

Source of the article : Wikipedia