Vocal fold pseudocyst: Results of 46 cases undergoing a uniform treatment algorithm

Authors

  • Christine Estes MM, MA,

    1. Sean Parker Institute for Voice Disorders, Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
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  • Lucian Sulica MD

    Corresponding author
    1. Sean Parker Institute for Voice Disorders, Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
    • Send correspondence to Lucian Sulica, MD, Dept of Otolaryngology–Head & Neck Surgery 1305 York Ave, 5th Floor, New York, NY 10021. E-mail: lus2005@med.cornell.edu

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  • Presented at the 2013 Meeting of the American Laryngological Association, Orlando, Florida, U.S.A,, April 9–10, 2013.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

To describe treatment results and identify predictors of the need for surgical intervention in patients with vocal fold pseudocyst.

Study Design

Retrospective cohort study with longitudinal followup via survey.

Methods

Clinical records were reviewed for demographic information, VHI-10 score, and degree of severity of dysphonia. Videostroboscopic examinations were evaluated for presence of vocal fold pseudocyst, along with additional clinical variables, including laterality, reactive lesion, paresis, varix, and hemorrhage. Follow-up surveys were sent to all participants to evaluate current VHI-10 score and degree of vocal limitation. Results were analyzed to determine predictors of surgery and recurrence of pathology.

Results

Forty-six patients (41F:5M) with pseudocyst (40 unilateral: 6 bilateral) were reviewed. Twenty-three (50%) had reactive lesions, nineteen (41%) had paresis by clinical criteria, 10 (22%) had varices, and 6 (13%) had hemorrhage on examination. All underwent initial behavioral management (2–12 sessions of voice therapy; mean of 8 sessions). Seventeen (37%) eventually required surgical intervention. No demographic or clinical variables proved predictive of surgical intervention. Follow-up surveys were completed by 63% of patients, and 79% agreed with the statement that they were not professionally limited by their voices.

Conclusion

This experience supports behavioral management as an initial intervention in patients with pseudocyst, sufficient by itself to restore vocal function in approximately two out of three patients. Neither initial severity nor any of the studied clinical findings predicted the need for surgery. The large majority of patients with pseudocyst are able to be treated effectively without impact in their professional function.

Level of Evidence

4 Laryngoscope, 124:1180–1186, 2014

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