Desnea Winston had smoked about two packs of cigarettes a day for 45 years. Her lung function had deteriorated to the point that she was always out of breath and needed to be on oxygen. About one month ago she began to have trouble with her voice becoming more effortful to produce. Swallowing also became very difficult.
On examination she breathed with pursed lips like many patients with COPD. On endoscopic examination she had a smooth surfaced mass on the left upper glottis that appeared cystic. It did not block off her breathing but when she closed her vocal cords to make a sound the mass completely covered her vocal cords, likely touching them and severely dampening their vibrations. This made sound production difficult.
During surgery, the mass was a cyst, mostly filled with air, but with some mucus present and was connected to the left saccule. She had filled the left saccule with air and apparently placed enough pressure on it to dilate and herniate the interior of the saccule up into the left false vocal cord. This is known as an internal laryngocoele.
She had filled the left saccule with air and placed enough pressure on it to dilate and herniate the interior of the saccule up into the left false vocal cord — an internal laryngocoele.
During surgery the bulk of the cyst was removed and the remainder left open so that it would remain decompressed and could no longer expand, since I expect that her effort to breathe from her COPD will remain the same. These herniated pockets of air can also expand out of the larynx into the neck (external laryngocoele) and have been seen in horn players who have a great deal of back pressure on their larynx when playing a horn.
What you learned
- A laryngocoele is a herniation of the saccule — the small gland at the bottom of the false vocal cord — that has been inflated by chronic elevated air pressure in the larynx.
- In Desnea Winston’s case, the effort of breathing with severe COPD provided enough back pressure to inflate her left saccule until it herniated upward into the false vocal cord (an internal laryngocoele).
- External laryngocoeles, which expand into the neck, are also reported in brass players who maintain high laryngeal back pressure during performance.
- Treatment involves removing the bulk of the cyst and leaving the base open so that it remains decompressed and cannot re-inflate.