A laryngocele is a rare, benign air-filled sac that forms when a small pouch in the voice box (larynx) abnormally expands. It develops from a structure called the laryngeal saccule, a tiny pocket located in the upper part of the laryngeal ventricle, the space between the true and false vocal cords. With an estimated incidence of about 1 per 2.5 million people per year, most doctors will rarely encounter one in practice.
How a Laryngocele Forms
Inside your larynx, there is a natural fold of tissue called the ventricle of Morgagni, which contains a small pouch (the saccule) that normally stays collapsed. In a laryngocele, this pouch dilates and fills with air, expanding upward within the false vocal fold while maintaining a connection to the airway. That open connection to the airway is actually the defining feature of a laryngocele and the key detail that separates it from a similar condition called a saccular cyst, which fills with mucus and has no connection to the airway.
The term “laryngocele” was coined by the 19th-century pathologist Rudolf Virchow, and the condition has historically been divided into internal, external, and combined types based on how far the sac extends. Internal laryngoceles stay within the larynx. External laryngoceles push through the membrane between the thyroid cartilage and the hyoid bone, appearing as a visible or palpable mass on the neck. Combined laryngoceles have both components. Some newer sources note that all laryngoceles originate inside the larynx, so the label “external” is somewhat misleading.
Causes and Risk Factors
The exact cause isn’t fully settled, but three main theories exist: a congenital predisposition (you’re born with a larger-than-normal saccule), chronically increased pressure inside the larynx, or mechanical obstruction of the ventricle.
Activities that repeatedly raise pressure in the throat are the most commonly cited triggers. These include chronic coughing, straining, glass blowing, and playing wind instruments. The sustained high pressure gradually stretches the saccule outward like a balloon. Certain laryngeal diseases, including cancer, can also block the ventricle and trap air, creating the conditions for a laryngocele to develop. This is why new laryngoceles in older adults sometimes prompt doctors to look for an underlying tumor.
The condition is more common in men than women, though the exact ratio varies across studies. One large review found men made up about 58% of cases, while earlier literature suggested a ratio as high as five to one. The average age at diagnosis is around 51 years, with a peak in the fifth and sixth decades of life.
Symptoms by Type
Most laryngoceles are actually asymptomatic and discovered incidentally during imaging for something else. When symptoms do appear, they depend on the type.
Internal laryngoceles sit inside the larynx, where they can press against the vocal cords and airway. They typically cause hoarseness, sore throat, coughing, difficulty swallowing, and in more severe cases, noisy breathing (stridor) or airway obstruction.
External laryngoceles tend to show up as a soft, compressible mass on the side of the neck, between the sternocleidomastoid muscle and the hyoid bone. A distinctive feature is that the mass gets noticeably bigger when you cough, hold your breath, or bear down (the Valsalva maneuver), because air is forced into the sac from the larynx.
Combined laryngoceles can produce symptoms of both types. They carry a particular risk: if someone presses on the external neck mass, air can be pushed inward, suddenly enlarging the internal component and causing breathing difficulty.
Laryngopyocele: When Infection Sets In
If the air-filled sac becomes infected and fills with pus, it’s called a laryngopyocele. This is the most serious complication. The infected sac swells rapidly, potentially obstructing the airway and requiring emergency intervention. Infected material can also be aspirated into the lungs, leading to bronchitis or pneumonia. A laryngocele that was previously painless and stable but suddenly becomes tender, swollen, and associated with fever should raise concern for this complication.
How It’s Diagnosed
Laryngoceles are most reliably identified on CT scanning, which clearly shows the air-filled sac and its relationship to the surrounding structures. On imaging, a classic laryngocele appears as a well-defined, air-containing pocket arising from the laryngeal ventricle. If the sac has become infected, it will appear fluid-filled rather than air-filled. Direct visualization of the larynx with a flexible camera (laryngoscopy) can also reveal the internal component bulging into the airway.
The key diagnostic distinction is between a laryngocele and a saccular cyst. Both arise from the same anatomical location, but a laryngocele is filled with air and communicates with the airway, while a saccular cyst is filled with mucus and has no such communication. Saccular cysts are more common in children, while laryngoceles are predominantly an adult diagnosis.
Treatment Options
Small, asymptomatic laryngoceles may simply be monitored. When treatment is needed, surgery is the standard approach, and the method depends on the size and type.
Internal laryngoceles can often be removed through the mouth using an endoscopic approach with a CO2 laser. The surgeon uses a microscope to visualize the sac through the airway, then carefully cuts away the mucosa overlying the laryngocele on the false vocal cord and removes or opens the sac. This approach avoids any external incision and generally has a shorter recovery.
Larger or combined laryngoceles typically require an external approach through a small incision on the neck. The surgeon dissects through the skin and muscle layers, isolates the sac, and follows it down to where it penetrates into the larynx. The neck of the sac is tied off and the laryngocele is removed. Some cases use a combined approach, working from both the neck and through the mouth simultaneously for better control.
One older technique, called marsupialization (where the sac is opened and left to drain rather than fully removed), carries a higher risk of recurrence because healing tissue can form a new cyst over the remaining sac wall. Complete excision, whether endoscopic or external, has an excellent track record. Across multiple published case series, no recurrences have been reported following complete endoscopic removal, and external approaches also show very low recurrence rates.