A disorder in which the laryngeal saccule is inflated and becomes abnormally enlarged. A common symptom of a laryngocele is hoarseness.

How it develops:

The laryngeal saccule, or laryngeal appendix, is a very small blind sac—a dead-end corridor, so to speak—which is located just above the vocal cords, one on each side, and is lined with glands that supply lubrication to the cords. When a person makes voice, it is possible for a little bit of the air being pushed up out of the trachea to slip into this saccule. If over time enough air enters the saccule with enough force, the saccule may begin to be inflated and stretched out, leading to a laryngocele.

In some cases, the air that slips into and inflates the laryngocele will slip back out again as soon as the person stops making voice, so that the laryngocele abruptly inflates and deflates with each start and stop of speech or voice-making. (The photos and video below are an example of this.) In other cases, the air cannot exit as easily, but it may be reabsorbed slowly during quiet times or during sleep—only to be inflated again at the next instance of more active speaking.

Laryngocele vs. saccular cyst:

A much more common disorder of the laryngeal saccule (compared with a laryngocele) is a saccular cyst, which can occur if the entrance to the laryngeal saccule becomes blocked. In this scenario, air is absorbed, but secretions build up and gradually expand the saccule.

Symptoms and treatment for laryngocele:

A common symptom is hoarseness, because while the saccule is inflated, it may press press down on the vocal cords, not allowing them to vibrate freely, or it may block the laryngeal vestibule just above the cords and partially muffle the sound produced by the cords. Standard treatment is surgical removal, through one of two approaches: a small incision on the neck that leads into the larynx from the outside, or a laryngoscope that is inserted through the mouth and down into the larynx so that the laryngocele can be removed using a laser.



Laryngocele: A Cause of Hoarseness
A laryngocele is a disorder of the saccule, or laryngeal appendix, in which air abnormally expands it. Watch this video to see how a laryngocele behaves in real-time, and why that can affect the voice.

Vallecular cyst

A vallecular cyst is a mucus-containing cyst in the vallecula. Such cysts are relatively common. Vallecular cysts are almost always asymptomatic and found during examination for another issue, such as a voice problem.

Photos of vallecular cyst:

Anterior Commissure Microweb

A tiny webbing between the vocal cords at the anterior commissure, where the two cords meet. Some think that an anterior commissure microweb can help to cause vocal nodules, but we do not see any such relationship.


Microweb: Series of 2 photos

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mid-membranous cord

Microweb (1 of 2)

Subtle vocal cord swellings, mid-membranous cord. This patient also has a microweb, not visible in this view.
microweb at the anterior commissure

Microweb (2 of 2)

Same patient, at closer range, showing the microweb at the anterior commissure.


Literally, “elephant skin.” Used in laryngology to refer to rough or thick mucosa. Most often seen in the interarytenoid area and is thought to be indicative of acid reflux or, sometimes, chronic bacterial infection. Pachyderma does not typically affect the voice, though the underlying cause of the pachyderma can (e.g., chronic inflammation from acid reflux or chronic bacterial laryngitis). In such a case, the true vocal cords themselves appear intensely red.


Pachyderma, caused by laryngitis sicca: Series of 3 photos

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Pachyderma (1 of 3)

Pachyderma, here referring to the heaped up mucosa in the interarytenoid area, in a patient with laryngitis sicca.
Adducted (voicing) position

Pachyderma (2 of 3)

Adducted (voicing) position. Note that the pachyderma does not interfere with closure of the cords. In this case, the pachyderma does not directly affect the patient’s voice, which is typical, but the more generalized inflammatory condition (see the redness of the cords) does.
stippled vascular markings

Pachyderma (3 of 3)

Narrow-band lighting. This shows some stippled vascular markings, often seen with chronic inflammation or HPV infection.

Elephant skin: Series of 1 photo

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Elephant skin (1 of 1)

The namesake of this phenomenon of rough or thick mucosa: elephant skin!

Saccular Cyst

A closed sac originating from a formerly open and functioning laryngeal saccule. An analogy for a saccular cyst is a velvet bag used to hold coins which has its opening cinched shut by a drawstring. The mouth of the saccule becomes blocked, and mucus secreted within the saccule cannot escape through the normal opening in the anterior ventricle. This closed sac gradually expands, causing the false cord and aryepiglottic cord to bulge; the sac can further expand over the top of the thyroid cartilage and into the neck.


Lateral saccular cyst, external approach: Series of 1 photo

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Lateral saccular cyst external approach

Lateral saccular cyst, external approach (1 of 1)

The hemostat in the lower photo points to the upper part of the thyroid cartilage. The neck of the sack is being followed over the top of the cartilage and between the thyroid cartilage and soft tissue, to its origin at the ventricle.

Supraglottic Cyst

A retention-type cyst of the supraglottic structures not manifesting as either an anterior or lateral saccular cyst. With a supraglottic cyst, the duct of a single gland is thought to become obstructed and to thereby retain secretions. By contrast, with a saccular cyst, the mouth of the laryngeal saccule becomes obstructed.


Post-Radiation Telangiectasia

Atypical dilation or formation of capillaries (typically seen in the laryngopharynx) as a mid- or long-term response to radiation. These are a benign but sometimes impressive-looking tissue change. Often, post-radiation telangiectasia does not appear until a year or more following the end of the course of radiation.


Mucus Retention Cyst

A cyst that forms when one of the mucus glands just below the vocal cord’s free margin becomes plugged. Mucus glands in this location secrete mucus in order to bathe and lubricate the vocal cords, but if a gland becomes obstructed, then the mucus it produces gets trapped and accumulates, leading to a mucus retention cyst. A mucus retention cyst typically occurs without any correlation to vocal overuse, in contrast to epidermoid cysts as well as nodules and polyps.


A mucus retention cyst can cause hoarseness, because it interferes with the normal vibrations of the vocal cords and the accuracy of their match with each other (see the videos below). The cyst is most often unilateral—that is, occurring on one cord but not the other. It appears as a bulge or deformation of the vocal cord’s free margin, and sometimes undersurface, and it may be yellowish in color.


The cyst may be surgically removed, by creating a small incision on the vocal cord and then dissecting the cyst from the cord. Photos of the surgical process can be found below. Also, the two videos below show how removing this kind of cyst can improve the voice.



Mucus Retention Cyst: Before and After
Watch this video to see images and hear audio of a mucus retention cyst’s effect on the vocal cords, followed by the surgical removal and the post-surgical results.
Mucus Retention Cyst II: Before and After
Another example of a mucus retention cyst, with images and audio before, during, and after the cyst’s surgical removal. This video highlights a bit more of the vocal capability battery.


A white patch found on the mucosa anywhere in the body. In the larynx, leukoplakia is most often seen on the vocal cords, either in long-time smokers or in individuals with some other cause of chronic inflammation. Leukoplakia is the descriptive term for what, on biopsy, may prove to be keratosis, carcinoma in situ, or carcinoma.


Laryngopharynx acid reflux disease (LPRD)

A constellation of symptoms and findings caused by reflux (backwards flow) of stomach acid into the throat or larynx, typically during sleep. Laryngopharynx acid reflux disease (LPRD) may be seen with or without the heartburn, acid belching, etc., commonly associated with gastroesophageal reflux disease (GERD). The classic symptoms of LPRD may be exaggerated in the morning and include one or more of the following: dry throat, rawness or scratchy sensation, increased mucus production and attendant throat clearing, husky voice quality or low-pitched morning voice, irritative cough, and, if one is a singer, the need for prolonged warm-up. For appropriate treatment measures, see GERD.

Sometimes acid reflux is diagnosed when it isn’t the real problem. The do-it-yourself trials in this downloadable article can help a person and his or her personal physician verify if acid reflux is the appropriate diagnosis: When Acid Reflux Treatment Takes You Down a Rabbit Trail

1. Originally published in Classical Singer, April 2009. Posted with permission.