Vocal CystA fluid collection that forms inside the vocal cord. It forms as the body’s response to an injury of the vocal cord.
What is a vocal cyst?
A vocal cyst is a fluid collection that forms inside the vocal cord. It forms as the body’s response to an injury of the vocal cord.
What does that mean?
A cyst can occur anywhere in the body. A cyst is a collection of fluid that forms due to trauma. The body swells with clear fluid and, at times, a wall can form around the collection of fluid. At that point, it is difficult for the body to reabsorb the fluid and the collection is called a cyst. Vocal cysts form when the vocal cord is injured from voice overuse or misuse. The vocal cords hit each other over 100 times per second when speaking and singing. If the voice is used incorrectly, the vocal cords swell due to the impact. If incorrect or excessive voice use continues, the fluid becomes walled off and forms a cyst inside the vocal cord.
How does the vocal cord get injured?
The most common ways for the vocal cord to be injured are related to voice use:
- Voice overuse
- Voice misuse (poor singing technique, shouting, etc)
- Coughing, throat clearing
- Poor vocal health (smoking, reflux, postnasal drip, etc)
- Smoking (tobacco, marijuana, etc)
- Acid reflux
- Postnasal drip
Once the vocal cord is injured, it is difficult for it to heal because people tend to ignore hoarseness. Continued talking on swollen cords will often result in a permanent vocal injury, such as a cyst.
Imagine what happens when you wear shoes that are too tight and form a blister. If you do not continue to wear those shoes, the blister will begin to heal. However, if you keep wearing those shoes, the injured area will not heal.
What are the symptoms?
The symptoms of a vocal cyst varies according to your vocal demands.
If you are a vocational voice user (i.e., someone who uses their voice for their living, such as a singer, actor, voiceover artist, etc), you will possibly notice:
- Chronic hoarseness
- Pitch change in your speaking voice
- Significantly decreased range (no longer hitting higher notes easily)
- Inability to sing quietly
- Inability to hold a pitch steady
- Throat pain
- Voice fatigue
It is rare to be able to access your full vocal range with a cyst.
It is not easy to know if you have a cyst. One possible self-check is:
- After a good warm-up, attempt to glissando to the highest notes you can normally reach. If you are unable to reach them comfortably and consistently, without increased effort, you may have a cyst.
If you are an avocational voice user, you will possibly notice:
- Hoarseness in your speaking voice
- Throat pain
- Voice fatigue at the end of the day
What does a cyst look like?
A cyst will look like a rounded mass inside the vocal cord. The edge of the vocal cord will often have a rounded shape due to the mass inside it. The other vocal cord will often swell or have scarring due to the trauma of being contacted repeatedly by the cyst.
On stroboscopy, the cord may not vibrate at all because the cyst dampens the vibrations. In cases of smaller cysts, the vibration may be less affected.
How do I know if I have a cyst?
The only way to know if your symptoms are due to a cyst is to have your vocal cords examined. This requires the use of videostroboscopy by a laryngologist.
Cysts are often missed when regular flexible laryngoscopy through the nose is used.
Complications of a cyst
Are there possible complications of a cyst?
There are definitely major complications of cysts, particularly when the diagnosis is made late. Complications include:
- Permanent hoarseness
- Permanent loss of vocal range
- Need for surgery
How can I avoid having a complication?
Early diagnosis is the key to avoiding these complications. This means coming in for evaluationas soon as you are hoarse.
Truths & Myths
I hear so many conflicting things about cysts? What is the truth?
Myth: A cyst means the end of my career.
Truth: Cysts have a major impact on the voice. It is true that your voice may never be the same after having a vocal cyst. However, many singers are able to sing with vocal cysts, as long as treatment is optimized.
Myth: Cysts require surgery.
Truth: The unfortunate truth is that cysts rarely resolve on their own. If the top priority is having the cyst go away, this often requires surgery. However, with excellent treatment, a singer can compensate for the cyst and may never need surgery.
Myth: Cysts are not preventable.
Truth: It is true that cysts are sometimes unavoidable, such as those that are due to chronic coughing. However, the vast majority is due to voice misuse or overuse and these are preventable. If good vocal hygiene is used, you should be able to prevent a cyst from forming. Having an exam before you have a problem can detect problems with vocal hygiene and technique.
What is the treatment?
Treatment is most effective when a cyst is caught early and diagnosed correctly.
This may seem simple, but without videostroboscopy it is much more difficult.
How do you handle vocal cysts?
The best treatment is accurate diagnosis. Unfortunately, most patients who come for evaluation do so after many other ENTs have inaccurately diagnosed them with nodules. Any singer or voice user who notices a change in their voice should seek immediate attention from a laryngologist.
Medications and vocal hygiene are required to give the best chance of recovery without surgery.
At the Division of Voice and Laryngology at Osborne Head and Neck Institute (OHNI), we understand that your voice is your livelihood. We take the utmost care to prevent poor voice outcomes. Your evaluation at OHNI includes:
- A complete history
- A complete physical exam of the head and neck
- Treatment planning – this usually includes voice therapy with a skilled therapist, trained in the treatment of voice disorders
This comprehensive evaluation results in the best treatment plan for you, that will help prevent you from having future problems.
Can I just see my regular doctor?
Unfortunately, few people are trained to correctly diagnose and treat voice disorders. Only a laryngologist can accurately diagnose and treat you, and help prevent you from having a worse problem.
What should I ask my doctor when I see him/her to ensure I’m getting the right treatment?
You should ask your voice physician the following questions to ensure you are getting the treatment you deserve:
1.Are you board certified in ENT?
2.Are you fellowship-trained in laryngology/professional voice?
3.Do you perform videostroboscopy?
4.Do you perform the examination on your patients?*
5.When surgery is needed, do you perform the surgery yourself or are there other doctors or doctors-in-training involved?*
6.Do you accept insurance? Are your services covered by insurance?
*Often, laryngologists are located in facilities where residents or fellows (doctors-in-training) perform a large portion of the services.
Does insurance pay for a laryngologist visit?
If the laryngologist accepts insurance, your visit is usually covered. Laryngoscopy with stroboscopy is also usually covered. It is best to ask your doctor’s office billers to clarify insurance issues.