Behavior Intervention Effective in Most Patients with Vocal Fold Pseudocysts

How are vocal fold pseudocysts treated, and when do they require surgical intervention?

Background: A pseudocyst is a benign phonotraumatic lesion of the membranous vocal fold with a fusiform, translucent, blister-like appearance. Like other benign membranous vocal fold lesions, it causes dysphonia by means of its mass effect. Treatment recommendations range from voice therapy to microsurgical removal to medialization laryngoplasty, but intervention assessment is complicated by nonstandardized nomenclature.

Study design: Retrospective cohort study with longitudinal follow-up via survey of all patients with pseudocysts presenting to an urban university medical center’s laryngology service between Jan. 1, 2010, and March 31, 2012.

Setting: Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York City.

Synopsis: Forty-six patients with pseudocysts (40 unilateral, 6 bilateral) were reviewed; 23 had reactive lesions, 19 had paresis by clinical criteria, 10 had varices, and six had hemorrhage on examination. All patients were referred for behavioral management/voice therapy following definitive diagnosis and were reassessed afterward. Patients with continuing limiting symptoms, in whom significant further improvement was deemed unlikely, were offered surgical intervention. Surgery consisted of microlaryngoscopic removal of the pseudocyst and other mucosal pathology only. Of all participants, 29 returned to voice use following treatment with voice therapy alone, and 17 chose surgical intervention. Of the 17, two experienced pseudocyst recurrence within a two-year period. There was not a significant difference between patients who chose surgical intervention and those who returned to voice use following behavioral intervention. Of all variables analyzed, the presence of unilateral paresis was the most predictive of surgical intervention. A larger sample size would be needed to determine if the presence of vascular-related pathologies has any statistical significance related to surgical need. Acoustic and aerodynamic measurements and standardized behavioral treatment protocols would enhance this study information.

Bottom line: Behavioral management as an initial intervention in patients with pseudocyst can help restore vocal function in approximately two out of three patients; none of the studied examination findings predicted the need for surgical intervention.

Citation: Estes C, Sulica L. Vocal fold pseudocyst: results of 46 cases undergoing a uniform treatment algorithm. Laryngoscope. 2014;124:1180-1186.