Reactive swelling and cyst of the vocal fold.

This 16-year-old soprano, professional performer, high school student, and aspiring actress presented with a 2-month history of hoarseness, unstable pitch control, breathiness, and decreased volume. She had had singing lessons since the age of 9. Her dysphonia developed gradually, approximately 1 month after a period of heavy voice use. Initially, she noticed difficulty controlling her passagio (break between registers) and vocal fatigue. She also had symptoms of reflux laryngitis.

Strobovideolaryngoscopy (figure 1) revealed a large right vocal fold cyst (white arrows). This cyst involved more than 50% of the musculomembranous vocal fold. Near the posterior portion of the cyst, there was an abnormal, varicose vessel running perpendicular to the vibratory margin (black arrow). The figure also reveals arytenoid edema resulting from reflux, which was subsequently treated with proton pump inhibitors and lifestyle modification. In abduction (figure 2), left vocal fold contact swelling with hypervascularity can be seen (arrow). Although reactive swellings such as those seen in this patient frequently resolve with voice therapy alone, symptomatic cysts of this size generally require surgical resection.

From the Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University and Graduate Hospital, Philadelphia (Dr. Sataloff), and the American Institute for Voice and Ear Research, Philadelphia (Ms. Kelleher).