The border of vocal fold cysts contains squamous or epithelial cells. In the case of retention cysts, the border consists of glandular epithelium. Epidermoid cysts closely resemble epidermal cysts that can occur anywhere in the body. Types of Vocal Cord Cysts
Sub-epithelial cysts (also known as mucous retention cysts) are closed lesions that occur from a build-up of tissue on the vocal folds. They are typically found in the middle portion of the upper lamina propria of the vocal folds. Sub-epithelial cysts are small and white in colour. Their presence on the vocal folds usually does not disrupt the vibration of the vocal folds for speech (known as the "mucosal wave").Ligament cysts (also known as epidermoid cysts) are closed lesions that occur near the vocal ligament in the deep layers of the lamina propria. Ligament cysts are usually larger in size than sub-epithelial cysts. They are yellow in colour and unlike sub-epithelial cysts, their presence is usually observed to disrupt the mucosal wave of the vocal folds in the region around the cyst. Signs and Symptoms
Sub-epithelial vocal fold cysts and ligament vocal fold cysts are characterized by similar symptoms. The presence and severity of symptoms may be influenced by the location and size of the cyst.Common symptoms include:

Hoarse voice
Inability to produce high pitch notes
Fatigue when speaking
Limited pitch range
Pain near the larynx
Variations in pitch when speakingSigns and symptoms of vocal fold cysts may remain stable or increase over time. In rare cases it is also possible for symptoms to improve if the cyst ruptures spontaneously.
Narrow-band imaging involves the use of blue and yellow lights to improve the picture quality of an image and accentuate blood vessel visibility. NBI has been found to help improve visual identification of vocal fold cysts in some cases.Vocal fold cysts can be differentiated from other vocal fold growths as they are usually unilateral. The two types of vocal fold cysts (sub-epithelial and ligament cysts) can be differentiated by colour, size and location. (See section on Types of vocal cord cysts for more information.) If the vocal fold cyst(s) are presumed to be congenital, the patient should have a history of presenting with a hoarse voice.Patients with vocal fold cysts are considered for surgery when presenting with:
Dysphonia
Lack of improvement through voice therapy

Prevention
A key aspect of preventing vocal fold cysts is good vocal hygiene. Good vocal hygiene promotes the healthy use of the vocal apparatus and the avoidance of phonotrauma. Good vocal hygiene practices involve the avoidance of:
Shouting
Whispering loudly or for long periods of time
Frequently of talking over loud background noise
Talking while yawning
Continual clearing of the throat
Speaking in an unnatural voice (i.e. too high or low)
Talking with a cold or laryngitis
Smoking tobacco or marijuana
The consumption of alcohol and coffee
The use of antihistamines, aspirin, steroids, tricyclic antidepressants, or any substance that alters perception (i.e. sleeping pills)
Foul airIn addition, good vocal hygiene involves getting enough rest and drinking sufficient water. It is important to keep the vocal fold tissue healthy and hydrated, and when possible to limit the quantity of speaking in order to avoid damage.