Posterior Vocal Fold Cysts

A 69-year-old male presented to our office with a 2-year history of dysphonia described as breathy, strained, and course. His voice became worse with stress, prolonged use, and public speaking. He had particular difficulty forming words when speaking loudly. He also reported a 25-pack-year smoking history, and he quit smoking 15 years ago.

Examination via rigid videostroboscopy revealed laryngopharyngeal reflux, muscle tension dysphonia, glottic insufficiency, and Reinke’s edema. He had bilateral cysts located along the posterior third of the vocal folds, far from the striking zone, which is the middle of the musculomembranous portion of the true vocal folds (Figure 1).

Figure 1.

Bilateral vocal fold cysts located along the posterior third of the true vocal folds and associated with anterior and posterior glottic gaps.

Vocal fold cysts are benign lesions and can be associated with phonotrauma, chronic laryngitis, and infection. ¹ Typically, vocal fold cysts develop in the midportion of the true vocal fold at the striking zone, as opposed to the posterior third of the vocal fold medial to the tips of the vocal processes as seen in our patient. These lesions result in impaired glottic closure, which can contribute to dysphonia and lead to a breathy voice.

Treatment of vocal fold cysts may include surgical excision, but contact lesions and sometimes cysts can be reduced substantially through expert voice therapy. ^{1 –3} If voice therapy fails, surgical intervention often can improve voice quality. ⁴