Vocal fold pseudocyst: a prospective study of surgical outcomes.

OBJECTIVES/HYPOTHESIS To examine rates of lesion recurrence and functional impairment after surgical removal of vocal fold pseudocysts and determine factors predictive of recurrence. STUDY DESIGN Prospective cohort study. METHODS Patients who underwent surgical removal of pseudocyst were recruited for 12 months of postoperative follow-up. A clinical consensus cohort of 10 laryngologists blindly reviewed pre- and postoperative videostroboscopic examinations to determine presence of pseudocyst and concurrent clinical variables (reactive lesion, varix, paresis). Patients completed a postoperative Voice Handicap Index-10 (VHI-10) and follow-up questionnaire. Results were analyzed to determine lesion recurrence rates, degree of postoperative functional impairment, and predictors of recurrence. RESULTS Eighteen surgeries on 17 patients (15F:2M) with pseudocyst were examined. All underwent perioperative behavioral treatment. Lesion recurrence rates were 22% (per treating laryngologist) to 33% (per clinical consensus cohort). No demographic variables proved predictive of lesion recurrence. No clinical variables predicted recurrence, although there was suggestion of paresis as a contributing factor. Postoperative VHI-10 scores were within normal limits for all patients, but 12% of patients experienced recurrent functional impairment requiring further treatment. CONCLUSION Most individuals (15/17) returned to normal voice use without limitation after surgery. Some individuals appear predisposed to lesion recurrence, which occurs relatively swiftly. Demographic features and clinical variables are not predictive of recurrence. The role of glottic insufficiency related to recurrence warrants further study.