Vocal Fold Pseudocysts: Are Unilateral and Bilateral Lesions Distinct Entities?

Background: Unilateral vocal fold pseudocysts have been hypothesized to result from vocal fold paresis, but no explanation has been proposed for bilateral lesions. This study compares patients with unilateral to those with bilateral pseudocysts for insights into pathogenesis.

Methods: Adults with unilateral and bilateral pseudocysts evaluated between 2018 and 2023 were retrospectively studied. Patient demographics, laryngeal stroboscopic findings, management strategies employed, and treatment outcomes were recorded. Fisher's exact and student's t-tests were performed to assess unilateral and bilateral cohorts for differences.

Results: One hundred ninety-six patients (109 with bilateral and 87 with unilateral pseudocysts) were studied. The average age was 29 years (bilateral: 29 years, unilateral: 30 years; p = 0.3846). The groups differed with respect to sex (172 females: 105 bilateral, 67 unilateral; 24 males: 4 bilateral, 20 unilateral; p < 0.0001) and clinical diagnosis of paresis (bilateral: 13.8%, unilateral: 34.5%; p = 0.0010). Treatment was similar between cohorts for rates of voice therapy (bilateral: 67.0%, unilateral 63.2%; p = 0.6511) and surgery (bilateral: 12.8%, unilateral 17.2%; p = 0.4228). There were a total of six recurrences (bilateral: 2, unilateral: 4; p = 0.3898).

Conclusions: Bilateral pseudocysts occur almost exclusively in women and with a relative absence of paresis. Unilateral pseudocysts are more likely to occur in the presence of paresis and in a significantly higher proportion of men. This suggests that unilateral and bilateral disease evolve in different clinical conditions, although they may share glottic insufficiency as a predisposing factor.

Level of evidence: 3 Laryngoscope, 135:234-238, 2025.