I am a 20-year-old female and have been diagnosed with a vocal-cord cyst and one-sided laryngeal-nerve paralysis. My main symptoms are hoarseness and a weaker voice at the end of the day, especially after working. I am a student, work about 20 hours a week and am not a singer. Although my hoarseness is annoying, it doesn't really bother me much. Would you recommend surgical removal of the cyst? What are the pros and cons?

R.A.D.

PRO: Cyst removal MIGHT help your voice.

CON: Let's assume that you have been correctly diagnosed. You have listed two conditions (a cyst and a one-sided vocal-cord paralysis), either of which could account for your symptoms. Indeed, your hoarseness and weak voice may be due to both conditions. Treat one problem and ignore the other, and there is a very real possibility that your voice would be unchanged, or even worse.

Both problems ARE treatable, by the way. Cysts are best removed by a procedure known as a "microflap." You should run the other direction if the ear, nose and throat doctor (ENT) uses the phrase "vocal-cord stripping." Microflap is a minimally invasive technique in which the cyst is removed with as little damage as possible to the covering mucosa (mucous membrane) of the vocal cord. Stripping is as violent as it sounds: the surgeon grasps the vocal cord mucosa and pulls, removing cyst along with healthy tissue. I hope that there are few ENTs out there who treat cysts by stripping. My suspicion is that most ENTs try to be "minimally invasive" but do not actually practice a true microflap technique. That's because the technique is relatively new.

Treatment of vocal-cord paralysis is a much more complicated topic. First and foremost, WHY do you have this paralysis? If this question has not been answered, it must be investigated aggressively before any treatment is instituted. Some paralyses are temporary, while others are permanent. Some paralyses are symptoms of much more serious medical conditions. Here are a few of the more common causes of one-sided vocal cord paralysis: birth trauma (sometimes due to a stretch injury on the recurrent laryngeal nerve), surgical injury (from thyroidectomy, for example), trauma to the neck such as strangulation or a penetrating wound, a tumor compressing or invading the nerve, and viral inflammation of the nerve.

If the paralysis is relatively recent and the cause is unknown, then your ENT must rule out potentially serious problems, such as a tumor growing anywhere along the course of the nerve. If an aggressive search fails to reveal the cause, then the paralysis is "idiopathic" (i.e., cause unknown). Treatment is typically delayed six months or longer to allow time for spontaneous recovery. There is a test known as an EMG ("electromyography") in which the electrical activity of the vocal cord muscle is monitored; this can be very helpful in determining whether recovery is likely. Unfortunately, this test is not widely available.

If the paralysis is known to be permanent (for example, following a thyroid- gland surgery in which the nerve was severed), or if an idiopathic paralysis has persisted for longer than six months, surgical repositioning of the paralyzed cord (an operation known as a "thyroplasty") can give you a much stronger voice.