ConditionEar, nose & throat
Vocal Cord Cyst
A vocal cord cyst is a small, benign, fluid- or material-filled sac within the vocal fold, the vibrating tissue in the voice box (larynx). It stiffens the vocal fold so it cannot vibrate evenly, causing hoarseness, a breathy or rough voice, voice breaks, reduced range and vocal fatigue. Cysts are linked to voice overuse and blocked mucus glands, and are common in singers, teachers and other heavy voice users. Unlike vocal nodules, most cysts do not go away with voice therapy alone and often need precise microsurgery.
Also called: Vocal fold cyst, mucus retention cyst, epidermoid cyst of the vocal fold, intracordal cyst
At a glance
- What it is
- A benign sac within the vocal fold.
- Types
- Mucus retention cysts (from blocked glands) and epidermoid cysts (containing skin-like keratin).
- Symptoms
- Persistent hoarseness, breathy or rough voice, voice breaks, loss of high notes, vocal fatigue.
- Diagnosis
- Laryngoscopy with videostroboscopy by an ENT specialist.
- Treatment
- Voice therapy first; phonomicrosurgery to remove the cyst; voice rest and therapy after surgery.
- Outlook
- Most people regain a good voice after treatment.
When to get help
Call 911 or go to the ER
- Noisy or difficult breathing, especially with hoarseness
See a doctor within a day or two
- Hoarseness with coughing up blood, difficulty swallowing, a neck lump or weight loss
- Hoarseness lasting more than 4 weeks in a smoker or heavy drinker
Book a routine appointment
- Hoarseness lasting more than 4 weeks, or sooner if your job depends on your voice
- Voice tiring quickly, losing range, or breaking
Usually safe to manage at home
- Hoarseness during a cold that improves within 2 weeks with voice rest
What a vocal cord cyst is
The vocal folds are two bands of tissue that vibrate as air passes between them, producing sound. Their soft outer layer must be flexible to vibrate freely. A cyst sits within this layer, adding mass and stiffness, so the folds vibrate unevenly and may not close completely.
Types
- Mucus retention cysts: a small gland in the vocal fold becomes blocked and fills with mucus. These are often linked to voice overuse or inflammation.
- Epidermoid cysts: contain keratin and may result from trapped surface cells, sometimes from injury or present since birth.
- Sulcus or ruptured cysts: a cyst that has opened can leave a groove in the vocal fold.
Cysts are usually on one side, but the opposite fold often develops a reactive swelling from contact.
Causes and risk factors
- heavy or forceful voice use: singers, teachers, coaches, call-center workers, actors
- shouting, screaming or prolonged loud talking
- vocal trauma during laryngitis
- laryngopharyngeal reflux
- smoking and irritants
- possibly congenital factors for epidermoid cysts
Symptoms
- persistent hoarseness, roughness or breathiness
- voice breaks or cracking
- reduced pitch range, especially difficulty with high notes
- vocal fatigue after use
- a feeling of something in the throat
- needing more effort to speak or sing
- occasionally throat discomfort
Vocal cord cysts vs nodules and polyps
| Cyst | Nodules | Polyp | |
|---|---|---|---|
| Sides | Usually one side | Both sides, symmetrical | Usually one side |
| Cause | Blocked gland or trapped cells | Repeated vocal strain | Vocal trauma, sometimes a single event; smoking |
| Appearance | Smooth, round, under the surface | Callus-like bumps | Soft, fleshy, may bleed |
| Response to voice therapy | Often partial | Usually good | Variable |
| Surgery | Often needed | Rarely needed | Often needed |
Diagnosis
- Laryngoscopy: a camera passed through the nose or mouth to view the vocal folds.
- Videostroboscopy: a strobe light shows vocal fold vibration in slow motion, revealing cysts that can be hidden beneath the surface and their effect on vibration.
- Voice assessment by a speech-language pathologist: acoustic analysis and perceptual evaluation.
Some cysts are only confirmed during surgery. Persistent hoarseness, especially in smokers, also requires exclusion of laryngeal cancer.
Treatment
Voice therapy
Usually tried first, and also used before and after surgery. A speech-language pathologist teaches efficient voice production, reduces compensatory strain (muscle tension dysphonia often coexists) and improves vocal hygiene. It may reduce swelling around the cyst but rarely makes the cyst disappear.
Phonomicrosurgery
Under general anesthesia, a surgeon uses a microscope and fine instruments through the mouth to make a small incision in the vocal fold surface, remove the cyst completely, and preserve the surrounding tissue to protect the voice.
- a period of complete voice rest, often several days, follows surgery
- gradual return to voice use under the guidance of a speech-language pathologist
- singers usually return to performing after several weeks to a few months
Other measures
- treat reflux if present
- stop smoking
- hydrate well and use humidification
Outlook
With proper surgery and rehabilitation, most people recover a clear, strong voice. Recurrence is uncommon after complete removal. Ongoing vocal hygiene helps protect the voice.
Frequently asked questions
What is a vocal cord cyst?
A vocal cord cyst is a small, benign sac filled with mucus or keratin inside the vocal fold. It stiffens the fold and disrupts vibration, causing hoarseness, a breathy or rough voice, voice breaks and vocal fatigue.
What causes vocal cord cysts?
Most are caused by a blocked mucus gland in the vocal fold, often related to heavy voice use or inflammation. Others form from trapped surface cells, sometimes after vocal injury. Reflux and smoking may contribute.
Can a vocal cord cyst go away without surgery?
Usually not completely. Voice therapy can reduce surrounding swelling and improve voice use, which helps some people enough to avoid surgery. Many cysts, however, need microsurgical removal for the voice to fully recover.
How is a vocal cord cyst different from a nodule?
Nodules form on both vocal folds from repeated strain and usually improve with voice therapy. Cysts are usually on one side, sit beneath the surface, and more often need surgery.
How long is recovery after vocal cord cyst surgery?
After surgery, most people need several days of voice rest, followed by gradual voice use with therapy. Everyday speaking often returns within 1 to 2 weeks, while full recovery for singers can take several weeks to a few months.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Otolaryngology-Head and Neck Surgery: Clinical practice guideline, hoarseness (dysphonia) update (2018)
- American Speech-Language-Hearing Association: Vocal cord nodules and polyps
- National Institute on Deafness and Other Communication Disorders (NIDCD): Vocal fold nodules, polyps, and cysts
- American Laryngological Association: Vocal fold cysts
- MedlinePlus: Hoarseness