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Draft: treatment of vocal fold cysts

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Vocal fold cysts are treated using a multidisciplinary approach.[1][2] Voice therapy to address harmful vocal behaviours is recommended as the first treatment option.[3] Voice therapy may involve reducing tension in the larynx, reducing loudness, reducing the amount of speech produced, and modifying the environment.[4] However, voice therapy alone is unlikely to restore near-normal functioning for professional voice users[3] or to cure the cyst.[1] If symptoms are significant, treatment usually involves microsurgery to remove the cyst.[3]

During surgery, attempts are made to preserve as much vocal fold tissue as possible,[3] given that glottal insufficiency (a gap in the vocal folds) is a possible consequence of surgery.[1] Vocal fold tissue can be preserved during surgery by raising a microflap, removing the cyst, then laying the flap back down.[1] This is intended to lead to minimal scarring and improved voice function.[1] However, if any epithelium from the cyst sac is left behind during surgery, the cyst may regrow.[5] Surgery of the larynx may also be conducted using a CO2 laser, which was reported as early as the 1970s.[6] Congenital ductal cysts (those caused by blockage of a glandular duct) may be treated by marsupialization.[7]

Following surgery, patients are recommended to take 4 to 14 days of vocal rest.[3] In absolute vocal rest, activities such as talking, whispering, whistling, straining, coughing, and sneezing are restricted.[8] Once adequate healing has occurred, the patient may be transitioned to relative vocal rest, which typically involves 5 to 10 minutes of breathy voicing per hour.[8] Voice therapy is then required to restore as much function as possible.[3] Post-operative voice therapy may include addressing harmful vocal behaviours, exercises to restrengthen the larynx, and reintegration into normal voice activities.[9]

Professional voice users who do not experience substantial limitations due to their cysts may choose to forego surgery.[5] Considering that some cysts remain stable over long periods of time, voice therapy alone may be an option for those who are resistant to surgery.[1] Another option for those who are unwilling to undergo surgery is vocal fold steroid injection (VFSI).[10] Injection of the vocal folds may be done transorally or percutaneously, through the thyrohyoid membrane, thyroid cartilage, or cricothyroid membrane.[10] After VFSI, patients are recommended to take 1 to 7 days of vocal rest.[10] VFSI may also be used to delay surgery, or as a treatment method when the risks associated with surgery are deemed to be too high.[10]

Brainstorming

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Potential draft improvements:

  • Link to vocal fold cyst article from vocal rest article, carbon dioxide laser article

Potential lead section contribution:

Initial treatment of the cysts involves voice therapy to reduce harmful vocal behaviours. If symptoms remain, patients may require surgery to remove the cyst. Surgery is typically followed by vocal rest and further voice therapy to restore voice function. Cysts may also be treated using vocal fold steroid injection.

Vocal-fold cyst Article Contributions

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With a group of classmates, I will be revising and adding to the article on vocal fold cysts. We intend to add sections for signs and symptoms, causes, diagnosis, treatment, prevention and prognosis. I will be mainly responsible for creating an informative section on treatment of vocal fold cysts. Based on a brief review of the literature, I intend to address both surgical and speech-language therapy options. Together, we will draft a cohesive introduction section for this article.

Working Bibliography

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  1. ^ a b c d e f Costello, Declan; Sandhu, Guri, eds. (2016). Practical Laryngology. Boca Raton, FL: CRC Press, Taylor & Francis Group. ISBN 978-1-4441-8367-2. {{cite book}}: |access-date= requires |url= (help)
  2. ^ Lin, Fred Y.; Patel, Zara M., eds. (2014). ENT Board Prep: High Yield Review for the Otolaryngology In-service and Board Exams. New York, NY: Springer. ISBN 978-1-4614-8354-0. {{cite book}}: |access-date= requires |url= (help)
  3. ^ a b c d e f Franco, Ramon A.; Andrus, Jennifer G. (October 2007). "Common Diagnoses and Treatments in Professional Voice Users". Otolaryngologic Clinics of North America. 40 (5): 1025–1061. doi:10.1016/j.otc.2007.05.008. {{cite journal}}: |access-date= requires |url= (help)
  4. ^ Colton, Raymond H.; Casper, Janina K.; Leonard, Rebecca (2006). Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment. Baltimore: Lippincott Williams & Wilkins. ISBN 9780781742399.
  5. ^ a b Altman, Kenneth W. "Vocal Fold Masses". Otolaryngologic Clinics of North America. 40 (5): 1091–1108. doi:10.1016/j.otc.2007.05.011.
  6. ^ Benninger, Michael S. (2000). "Microdissection or Microspot CO2 Laser for Limited Vocal Fold Benign Lesions: A Prospective Randomized Trial". The Laryngoscope. 110 (S92). doi:10.1097/00005537-200002001-00001. ISSN 1531-4995.
  7. ^ Ahmad, Sidrah M.; Soliman, Ahmed M.S. (February 2007). "Congenital Anomalies of the Larynx". Otolaryngologic Clinics of North America. 40 (1): 177–191. doi:10.1016/j.otc.2006.10.004. {{cite journal}}: |access-date= requires |url= (help)
  8. ^ a b Myers, Eugene N. (2008). Operative Otolaryngology: Head and Neck Surgery, Second Edition. Saunders. ISBN 978-1-4160-2445-3.
  9. ^ Ballif, Catherine L.; Gorman, Stephen; Kelchner, Lisa N.; LeBorgne, Wendy D.; Rettig, Jennifer R. "Postsurgical Vocal Rest Recommendations" (PDF). Retrieved November 6, 2016.
  10. ^ a b c d Wang, Chi-Te; Liao, Li-Jen; Cheng, Po-Wen; Lo, Wu-Chia; Lai, Mei-Shu (2013). "Intralesional steroid injection for benign vocal fold disorders: A systematic review and meta-analysis". The Laryngoscope. 123 (1): 197–203. doi:10.1002/lary.23551. ISSN 1531-4995.
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