A Retrospective Study of Glottic Cyst Histopathology and Its Clinical Presentation.

To understand the frequency and clinical presentation of the four types of vocal-fold cyst described by the Koren classification. Glottic cysts operated in a 1-year period were grouped retrospectively into Koren A, B, C and D (KA, KB, KC, KD). The age and sex of the patient, cyst location, laterality, associated lesions, profession, daily water consumption, duration of symptoms prior to surgery and postoperative healing time were noted. Of 30 cysts, 14 KA, 10 KB, 4 KC and 2 KD were identified. Average age of symptoms in KA to KD was 45, 52, 40 and 37 years. KC and KD were found only in females unlike the male predominance of KA and KB. Striking zone was the location of 28/30 cysts with a focal pit in 1 KC and mucosal bridge in 1 KD. There was no significance to laterality or profession. Average daily water consumption was 1.8, 1.75, 2 and 2 L in KA to KD. Average duration of symptoms up-till surgery for KA to KD was 2.6 years, 1.4 years, 2.9 years and 1 month. Post-operative healing time for KA to KD was 6.6, 7.4, 11.7 and 10 weeks. KA was the commonest cyst excised followed by KB, KC and KD. The KD patients were earliest and youngest to present. All KC and KD cysts were found in females unlike the male predominance of KA and KB. As majority of the cysts were found on the striking zone, phonotrauma may be one of the etiologies for all four cysts.

Office-Based Laser Therapy for Vocal Fold Cyst: A Promising Alternative Therapy Using the 445 nm Blue Laser.

Vocal fold cysts are benign lesions commonly encountered in laryngology practice. They are traditionally classified as mucus retention cysts and epidermoid cysts. The mainstay treatment is surgical excision with diligent dissection of the cyst wall. The authors of this manuscript report a series of two cases of vocal fold mucous retention cysts and one case of vocal fold pseudocyst treated with the blue laser (Wolf TruBlue 445 nm; A.R.C. Laser Company) in an office setting. All three cases had complete regression of the lesion with improved glottic closure and mucosal waves during phonation. The disease regression was associated with a decrease in the VHI-10 score, perceptual voice evaluation scores, and acoustic perturbation parameters. There was also an increase in maximum phonation time in all three cases. The authors advocate office-based blue laser therapy for vocal fold cysts as a promising treatment modality, particularly in patients at high risk for general anesthesia. Nevertheless, the possible increased risk of vocal fold scarring given the lack of binocular microscopic examination should not be underestimated. A larger study is needed to cast more information on the surgical outcome and long-term effects of blue laser therapy in the management of vocal fold cysts.

Systematic Review of Recurrence Rates of Benign Vocal Fold Lesions Following Surgery.

OBJECTIVES: Benign vocal fold lesions which include vocal fold nodules, polyps, cysts and other lesions often recur after surgery and require additional treatments. This systematic review of the current literature evaluated the effects of adjunctive therapies in addition to surgical resection on the recurrence rates of benign vocal fold lesions in adults. STUDY DESIGN: Systematic review. METHODS: A search using relevant keywords in electronic databases was conducted. Extracted data include author, year of publication, patient demographics, diagnostic approach, lesion type, surgical procedure, type of adjunctive therapy and the rates of recurrence. Descriptive statistics were performed on the collected data when appropriate. RESULTS: Eleven articles were identified with a total of 1085 patients. The total 1101 lesions studied included 591 (53.7%) polyps, 125 (11.4%) nodules, 146 (13.3%) cysts, 184 (16.7%) pseudocysts, 19 (1.7%) midfold masses, 18 (1.6%) sulcus vocalis and 18 (1.6%) varices. Besides surgery, adjunctive therapies included voice therapy, steroid injection and reflux medication. There were 141 reported lesion recurrences, with an average recurrence rate of 13.0%. The recurrence rate in studies with adjunctive therapies was 7.14%, and in studies with no adjunctive therapies it was 24.44%. CONCLUSIONS: Available evidence suggests that adjunctive therapies following surgery are associated with decreased lesion recurrence rates. However, due to differences in sample size, inconsistent reporting of lesion characteristics, heterogeneity of adjunctive therapies, variability in follow-up time across studies, and other factors, it is not possible to determine exactly which adjunctive therapies are of significant benefit and which lesion types may benefit the most.

Combining Voice Rest and Steroids to Improve Diagnostic Clarity in Phonotraumatic Vocal Fold Injury.

OBJECTIVES: (1) To describe a combination voice rest and steroid regimen to clarify ambiguous diagnoses in singers who present with phonotraumatic lesions and (2) to determine which videostroboscopic parameters show the most consistent response to this regimen. STUDY DESIGN: Chart review. METHODS: Singers with phonotraumatic vocal fold lesions seen at a tertiary care voice center over a 10-year period were identified. Those who had uncertain diagnoses on initial presentation, completed a combination regimen including voice rest and steroids, and had follow-up examinations were included in the analysis. The effect of this combination regimen was assessed by ratings of pre- and postregimen videostroboscopy examinations and by auditory perceptual ratings. Whether the combination regimen clarified the diagnosis was noted. RESULTS: Twenty-nine singers were prescribed the combination regimen with the intent to clarify the diagnosis. In 79% (23/29) of these singers, the regimen helped clarify diagnosis, for example, ruling in or ruling out specific lesions, confirming areas of scar, or distinguishing acute from chronic phonotraumatic injury. Stroboscopic exams were improved in 86% (25/29). The most common stroboscopic finding was a reduction in the lesion size (66%). Auditory perceptual ratings improved in 48% (14/29) of patients. CONCLUSIONS: A "cool down" combination of voice rest and steroids can improve diagnostic clarity in a subset of singers with phonotraumatic lesions. This combination regimen can be considered, with both the side effect profile of steroids and possible financial ramifications of strict voice rest in mind, when the initial diagnosis is unclear.

Vocal Fold Cyst Formation after Photoangiolytic KTP Laser Treatment of Early Glottic Cancer.

OBJECTIVE: The incidence of post-operative glottic cyst (POGC) formation in patients treated with transoral laser microsurgery with potassium-titanyl-phosphate laser (TLM-KTP) photoablation of early glottic carcinoma (EGC) has not previously been described. METHODS: A retrospective chart review was performed to identify all patients with early glottic cancer who underwent with single-modality TLM-KTP at our institution. Each patient received regular follow up with videostroboscopy for tumor surveillance. New glottic cysts seen on surveillance examinations were noted and their management was documented. RESULTS: A total of 33 patients met inclusion criteria. Eight patients (24%) developed POGC's within the original geographic perimeter of the cancerous vocal fold(s): 6 in the infraglottic region and 2 near the vocal process, at an average of 8 months after their initial cancer surgery. Of these 8 POGC's, 7 were at the periphery of the original tumor distribution and 1 was in the center of it. No POGC's were associated with any change in voice. Four of the 8 POGC's were phonosurgically excised, all without evidence of malignancy on pathology. The remaining 4 were monitored: 2 were stable for an average of 49 months of follow up; the remaining 2 resolved spontaneously by 7 and 31 months after first identification. CONCLUSIONS: POGC's are a frequent sequela of TLM-KTP for EGC. While these results suggest that they are unlikely to represent submucosal recurrences, surgeons should have a low threshold to biopsy if there is clinical concern for such and should counsel patients pre-operatively about the potential for their formation.

Diagnosis and Treatment of Benign Pediatric Lesions.

Dysphonia is common in pediatrics and affects individuals from infancy through their teenage years. Pediatric dysphonia has a variable impact on children, ranging from no impact to a severe social barrier. Although most etiologies are benign, potentially life-threatening causes must be ruled out by direct examination of the larynx. The most common benign lesions of the larynx in pediatrics are vocal nodules, vocal fold polyps, cysts, granulomas, ectasias, sulcus vocalis, and vascular lesions, including hemangioma and postcricoid cushion. Treatment of benign vocal lesions should be tailored to the individual patient and the perceived impact.

Updated Medical and Surgical Treatment for Common Benign Laryngeal Lesions.

Benign laryngeal lesions are often the result of phonotraumatic forces on the vocal folds and thus classically are treated with a combination of voice therapy and phonomicrosurgical techniques to minimize inadvertent additional trauma. Newer management strategies expand on these techniques with the use of the pKTP laser as well as intralesional injections, both in the operating room and in the awake outpatient setting.

Impact of Perioperative Voice Therapy on Outcomes in the Surgical Management of Vocal Fold Cysts.

INTRODUCTION: Vocal fold cysts are benign mid-membranous lesions of the true vocal fold, classified as mucus retention or epidermal inclusion cysts. Treatment is surgical excision with or without postoperative voice therapy. METHODS: A retrospective review was performed of the demographics, treatment approach, and outcomes of patients treated for vocal fold cysts between 2009 and 2014. Voice Handicap Index (VHI)-10 scores before and after treatment were compared using the Wilcoxon Rank-Sum test and the two-tailed Student's t test. Videostroboscopy examinations were reviewed for posttreatment changes in vibratory characteristics of the vocal folds. RESULTS: Twenty-five patients were identified, and one was excluded for incomplete records. Mean age was 41.9 years (66.7% female), and mean follow-up time was 5.58 months. Microflap excision was pursued by 21/24 (87.5%) patients, with 14 patients (58.3%) undergoing perioperative voice therapy. One cyst recurred. Two patients elected for observation, and their cysts persisted. VHI-10 decreased from 23.8 to 6.6 (P < 0.001) overall. There was a statistically significant reduction in VHI-10 in patients undergoing surgery with and without postoperative voice therapy (P < 0.004 and 0.001), but there was no significant difference between these two groups. Mucosal wave was classified as normal or improved in the majority. Cysts were characterized as mucus retention cysts in 19/21 (90%) and as epidermal inclusion cysts in 2/21 (10%). CONCLUSIONS: Vocal fold cysts impact mucosal wave and glottic closure. Surgical excision resulted in low rates of recurrence, and in improvement in the mucosal wave and VHI-10. Perioperative voice therapy did not offer a significant benefit. Mucus retention cysts were the majority, in contrast to other published studies.

Quantification of Vocal Fold Vibration in Various Laryngeal Disorders Using High-Speed Digital Imaging.

OBJECTIVE: To quantify vibratory characteristics of various laryngeal disorders seen by high-speed digital imaging (HSDI). METHODS: HSDI was performed on 78 patients with various laryngeal disorders (20 with polyp, 16 with carcinoma, 13 with leukoplakia, 6 with vocal fold nodule, and 33 with others) and 29 vocally healthy subjects. Obtained data were quantitatively evaluated by frame-by-frame analysis, laryngotopography, digital kymography, and glottal area waveform. RESULTS: Overall, patients with laryngeal pathologies showed greater asymmetry in amplitude, mucosal wave and phase, smaller mucosal wave, and poorer glottal closure than vocally healthy subjects. Furthermore, disease-specific vibratory disturbances that generally agreed with the findings in the literature were quantified: comparing polyp with nodule, differences were noted in longitudinal phase difference, amplitude, and mucosal wave. In comparison with leukoplakia and cancer, nonvibrating area was more frequently noted in cancer. CONCLUSIONS: The HSDI analysis of various voice disorders using multiple methods can help phonosurgeons to properly diagnose various laryngeal pathologies and to estimate the degree of their vocal disturbances.

Clinical analysis of COs-laser assisted suspension laryngoscopic surgery for vocal fold cyst / 中华显微外科杂志

Objective To compare the clinical effect between CO2-1aser assisted and cold instrument assisted suspension laryngoscopic surgery for vocal fold cyst.Methods From January, 2011 to December, 2014, 72 patients with vocal fold cyst, which diagnosed by strobolaryngoscopy, were randomly divided into CO2-1aser assisted group and cold instrument group.Strobolaryngoscopy, acoustic analysis and perceptual voice analyses were performed on each patient before surgery, 1 month, and 3 months after surgery, respectively.Results All operations were successfully completed.The complete vocal fold cyst resection rate of CO2-1aser assisted group was significantly higher than cold instrument group (29/36, 80.5％ vs 21/36, 58.3％, P ＜ 0.05), especially the left vocal fold cyst (13/16, 81.3％ vs 9/19, 47.4％, P ＜ 0.05).The complete right vocal fold epidermoid cyst resection rate was significantly higher than retention cyst (17/19, 89.4％ vs 11/18, 61.1％, P ＜ 0.05).Two recurrent cases were found in cold instrument group but no recurrent cases in CO2-laser assisted group (0/36, 0％ vs 2/36, 5.6％, P ＞ 0.05).Correlation analysis showed that vocal fold cyst recurrence was related to complete resection rate and has no relation with surgical methods, histopathological types and position.Subjective and objective assessment of voice quality in preoperative, 1-month postoperative and 3-month postoperative were similer between CO2-1aser assisted group and cold instrument group (P ＞ 0.05).Conclusion The CO2-laser assisted suspension laryngoscopic surgery for vocal fold cyst, can increase the surgical precision, reduce the left hand impact, improve the complete resection rate and reduce the recurrence rate.