The Natural History of Vocal Fold Cysts

Objective To determine the natural history of vocal fold cysts, by undertaking a retrospective analysis of data from a single clinical institute. Methods All patients diagnosed with vocal fold cysts were identified from January 2006 to June 2018. A total of 87 patients that elected not to have surgery or who had an interval of observation greater than 90 days prior to surgical intervention were further analyzed. The primary outcome was whether the cyst enlarged, reduced in size, resolved or ruptured. The secondary outcome measures were whether cyst characteristics (translucent or opaque by gross appearance and/or the presence of inflammation), voice therapy or duration of follow up (≤/> 300 days) had an impact upon natural history. Results There were 65 females and 22 males (47 years ±17). The mean duration of follow up was 589 days (Range 21 – 4523 days). The majority of cysts did not change (70.11%). The rest enlarged (12.64%), reduced in size (13.79%), resolved (1.15%) or ruptured (1.15%). There was no statistically significant relationship between the presence or absence of clinical signs of inflammation ( P = .633) or voice therapy ( P = .785) on natural history. There was an equivocal relationship between gross cyst appearance and natural history ( P = .054), however there was a statistically significant relationship between the duration of follow up ( P = .006) and natural history. Conclusion Most vocal fold cysts appear to remain static in size over time. About 30% change, with half of these enlarging and half shrinking. In addition to some possibility of change in size, there is a small chance of resolution or spontaneous rupture with potentially serious consequences to the voice. Level of Evidence 4. Laryngoscope , 130:2202–2207, 2020