User:Jaslyn.Dunger/sandbox

My contribution towards the article Vocal Fold Cysts will be focused on the Diagnosis and Prognosis section. The article is currently underdeveloped and does not yet have these sections defined; I will be defining the sections and adding appropriate information based on established medical sources. I will also be working together with other student editors to refine and edit the rest of the this article.

Idea for image: Atlas of Laryngoscopy, Vocal Fold Cyst section (Rutt & Sataloff)? Or, Bohlender (2013).

Lead section for Vocal Fold-Cysts, with edits in italics:

Vocal-fold cysts are collections of fluid in sac-like formations on the vocal folds. Cysts are often mistaken for early vocal fold nodules or polyps, due to the similar unilateral position of these growths (cite Casper).

Cysts can deteriorate the quality of human speech production, causing diplophonia, a condition where the vocal cords produce multiple tones at the same time, or dysphonia, an impaired quality of voice typically involving hoarseness or a breathy sound. Females are more likely than males to develop vocal fold cysts and the menstrual cycle may alter the size of the cyst (tag for citation regarding menstrual cycle). The cysts usually appear on one side of the vocal fold but may cause swelling on the opposite side due to irritation.

There are two types of vocal fold cysts: mucus retention, or intracordal cysts, and epithermoid cysts. Initial treatment of the cysts involves vocal training and speech therapy along with medical interventions to decrease irritation of the cyst. In many cases, these will alleviate problems from the cyst. In some cases, the cyst grows larger necessitating surgery to remove the cyst. Vocal professionals may also require surgery as the minimal steps do not improve the voice quality enough to allow continued performance with the voice.
 * Mucus retention cysts occur when a glandular duct becomes blocked and is unable to drain excess mucus (cite Casper). Because this fluid accumulates, retention cysts often become larger over time (cite Casper). This can occur after an upper respiratory infection combined with vocal overuse.
 * Epidermoid cysts result from either developmental problems before birth or from an injury to the mucous membrane. A ruptured cyst may result in a scar.

Diagnosis
Mucous retention cysts are most commonly seen in individuals that endure high vocal stress in their daily lives, while epidermoid cysts are usually congenital or second to vocal trauma (see lead section for more information on different types of cysts). The two types of vocal fold cysts can be differentiated from other vocal fold growths in several ways. Both types show decreased amplitude of vibrations and reduced or absent mucosal wave. Mucous retention cysts show a translucent mass of mucous usually below the free margin of the glottis, while epidermoid cysts are yellow masses under the first epithelial layer of the vocal folds. Epidermoid cysts generally appear in the superior and medial regions of the midmusculomembranous region of the folds, as opposed to mucous cysts appearing in the inferior region. Vocal fold cysts are differentiated from other vocal fold masses in that they are unilateral and subepithelial.

Four components to a full diagnosis are: medical and voice history, head and neck exam, then perceptual assessment of voice and imaging of vocal folds. The primary perceptual sign of vocal fold cysts is hoarseness of the voice. However, diagnosis is difficult; in most cases, when a diagnosis cannot first be reached via behavioural assessment and intervention, the patient undergoes an imaging procedure. Imaging is most commonly done with laryngeal videostroboscopy. This procedure provides information about vocal fold vibrations during speech, vocal intensity and vocal frequency. Imaging shows the reduced movement of the vocal folds (mucosal wave) when a vocal fold cyst is present.

Patients with vocal fold cysts are considered for surgery when presenting with :
 * Dysphonia
 * Lack of improvement through voice therapy

Prognosis
Following diagnosis, voice therapy should be implemented to optimize vocal hygiene. However, vocal fold cysts typically do not improve with solely vocal rest or vocal therapy. Instead, a surgical procedure utilizing the microflap approach is conducted to remove the cyst (see Treatment).

Following surgery, patients are advised to rest their voice for one week with gradual re-introduction of voice use with a Speech-Language Pathologist after this period of rest. This initial rest period can vary between 2 and 14 days. Patients with subepithelial cysts have a better prognosis for timely recovery of vocal abilities than patients with ligament vocal fold cysts. Typically, patients can resume speaking activities in 7-30 days following surgery, and singing activities 30-90 days post-surgery.

Up to 20% of patients show scarring, polyps or vascular changes of the vocal folds following surgery. In severe cases, these resulting symptoms may require further surgery. The patient must always be aware of the impact and potential complications of surgery on their voice, especially if the voice is heavily used occupationally. In these cases, post-operative therapy should be discussed.

Working Bibliography

 * 1) Colton, R. H., Casper, J. K., & Hirano, M. (1990). Understanding voice problems: A physiological perspective for diagnosis and treatment. Baltimore: Williams & Wilkins.
 * 2) Katherine, V. L. O. R. (2001). Review: Occupational risks for voice problems. Logopedics Phonatrics Vocology, 26, 1, 37-46.
 * 3) Monday, L. A., Cornut, G., Bouchayer, M., & Roch, J. B. (1983). Epidermoid cysts of the vocal cords. The Annals of Otology, Rhinology, and Laryngology, 92, 2.
 * 4) Roy, N., Barkmeier-Kraemer, J., Eadie, T., Sivasankar, M. P., Mehta, D., Paul, D., & Hillman, R. (2013). Evidence-based clinical voice assessment: a systematic review. American Journal of Speech-Language Pathology, 22, 2, 212-26.