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Rare cause of voice muffling: pyogenic vallecular cyst
  1. Lorna Kang Ni Ting1,2,
  2. Anuar Idris2 and
  3. Marina Mat Baki1
  1. 1Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
  2. 2Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
  1. Correspondence to Professor Marina Mat Baki; marinamatbaki{at}


A vallecular cyst is a benign laryngeal cyst that rarely causes symptoms in adults. We report a rare case of an infected vallecular cyst in a man who is in his 60s with diabetes mellitus. The patient presented to us with acute onset of voice muffling and respiratory distress. He showed signs of sepsis and upper airway obstruction. He had spikes of high-grade fever with an elevated total white cell count (predominantly neutrophil count) and C reactive protein level. Plain cervical X-ray revealed a large, smooth, lobulated mass in the vallecular area. Direct laryngoscopic findings supported the diagnosis of an infected vallecular cyst with suppuration, which originated from the vallecula fossa. The cyst was drained and excised completely, and the pus culture revealed the presence of Klebsiella pneumoniae. The patient responded well to the administration of intravenous cefuroxime for 2 weeks according to the sensitivity and culture test. He was discharged after the completion of the course of antibiotics, having recovered fully. This case illustrates the versatility of a plain cervical X-ray in giving clues about this rare, unexpected pathology.

  • Ear, nose and throat
  • Infectious diseases
  • Otolaryngology / ENT

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  • Contributors LKNT was involved in planning, acquisition of data and writing of original draft including literature review preparation. AI was involved in conducting and editing of the original draft. MMB was involved in conception, reviewing, supervising and final editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.