In Response to Letter to the Editor Regarding: A 10‐Year Study of the Etiopathogenesis of Cysts With a Study of Seromucinous Glands in Vocal Folds

Abstract

We thank the authors for their comments regarding our article "A 10-Year Study of the Etiopathogenesis of Cysts With a Study of Seromucinous Glands in Vocal folds." 1 Here are our responses.They have incorrectly stated our definition of decreased/inadequate laryngeal hydration as "daily consumption of ≤ 4 glasses of water/beverages." (p2) We considered inadequate laryngeal hydration as ≤4 glasses of water or consumption of >8 beverages (tea/coffee/cola) a day." 1(p2) Excessive tea/coffee/cola has a dehydrating action and cannot be grouped with water. 2,3 In addition, we did not use the term "VF dehydration." (p2) Regarding medication and daily activity causing dehydration, the personal history taken of all patients included this history. There was no medication used that results in obvious decreased hydration; all diabetic patients were well controlled, and none of our patients were athletes. Although humidity varies in each region, our study revealed decreased laryngeal hydration as a significant associated finding in cysts excised as compared to polyps excised, 1 wherein the patients operated for both cysts and polyps hailed from geographically similar areas. Regarding the reflux finding score (RFS), in the peer-reviewed article by Belafsky et al., 4 the study reveals that although each item alone was unable to predict the presence or absence of laryngo-pharyngeal reflux (LPR), the total RFS score was highly suggestive of LPR. 5 We have clearly stated what we mean by striking zone lesions "(junction of anterior one third and posterior two thirds of the vocal fold)" 1(p2) and that diagnosis was by stroboscopy. This diagnosis was made having seen the entire vocal fold, including the anterior commissure, by flexible or rigid stroboscopy or both.Regarding the experience of the laryngologist improving over time, our study was a retrospective one for which the laryngologist had a 25-year experience at the time of study. The final diagnosis was based on histopathology of cysts and polyps excised. 1 Regarding not differentiating between mucous and epidermoid cysts, in our study not only have we differentiated between them and given the statistics for both types of cysts separately, but we have further described them into the four histopathological types based on Koren's 6 classification. Both the Martin et al. 7 and Milutinovic and Vasiljevic's 8 studies have concluded a role of phonotrauma for mucous retention cysts, so it is incorrect to state that the articles referred to by us have not differentiated in the types of cysts when discussing phonotrauma. "One study being characterized by a higher proportion of EC" does not hold any ground because Milutinovic and Vasiljevic's study concludes a functional aspect to the etiology of retention cysts, as does our study. NUPUR KAPOOR NERURKAR, MS (ENT)

Vocal Fold Cyst Formation after Photoangiolytic KTP Laser Treatment of Early Glottic Cancer

“…Smoking is overall correlated with the development of benign vocal fold lesions. 14 We suspect the additional insult of KTP laser microtrauma to seromucinous glands and / or their ducts in the vicinity of the glottis may further increase the risk of cyst development in this susceptible population, notwithstanding the already higher chance of recurrent head and neck cancer in patients who continue to smoke. 13…”