Epiglottic cysts are common and frequent diseases in otorhinolaryngology. Epiglottic cysts are often caused by obstruction of the mucous ducts of the epiglottis, which is somewhat like a “sebaceous cyst” on the skin, and most of them appear laryngoscopically as a smooth yellowish-white spherical mass on the lingual surface of the epiglottis. Some patients are found because of throat discomfort and foreign body sensation, while others are found by chance during a physical examination. What should I do if an epiglottis cyst is diagnosed? Frankly speaking, an epiglottic cyst is a benign mass with little to no malignancy and a slow growth rate, and many patients’ symptoms of throat discomfort may not be related to it, so if the cyst is not particularly large, you can adopt an observation strategy and follow up regularly. However, not dealing with cysts can have a certain psychological impact on some patients, who always feel like a lump in their throat and want to spit it out. Patients who originally had a foreign body sensation in the throat may feel the obstruction more and more serious the more they think about it, and patients who were originally asymptomatic and found only on physical examination may be overly concerned about the throat, leading to varying degrees of symptoms instead. It is true that an epiglottic cyst may slowly increase in size, and the possibility of respiratory distress due to airway obstruction or enlargement of a giant cyst after infection cannot be ruled out. Currently, the common treatment for epiglottic cysts is to remove the cyst under direct laryngoscopy after hospitalization and general anesthesia, or to remove most of the parietal wall if the cyst is large to achieve the effect of “uncovering and draining”. Sometimes, in order to remove the cyst wall completely, the normal tissues may be damaged, which may cause bleeding; if the operation is not complete, it is easy to recur. In any case, “minor surgery, major anesthesia” plus hospitalization is always a costly and time-consuming task. The patient is then in a dilemma! We suggest a compromise solution to this embarrassing dilemma – Holmium laser laryngoscopic excision of epiglottic cysts. Under the supervision of a rigid laryngoscope with magnification, just like removing a fish spike, the surgeon introduces a thin optical fiber through a curved tube into the laryngopharynx and uses the thermal effect of the holmium laser to break the cyst, release the fluid, and cauterize the cyst wall. The treatment does not require hospitalization and can be done on an outpatient basis; it also does not require general anesthesia and usually requires only a few sprays of local anesthetic on the surface of the throat, which can be done except for a few patients with abnormal pharyngeal sensitivity who cannot cooperate. The method has satisfactory results and a low recurrence rate, taking only ten minutes or so, and the treatment can still be repeated even if it recurs. Because of the small penetration of holmium laser, less than 1 mm, the positioning is precise, tissue damage is small, complications are mild and recovery is fast. Therefore, holmium laser treatment of epiglottic cysts under laryngoscopy offers a two-pronged option for patients with epiglottic cysts who do not want to be hospitalized or undergo general anesthesia and have concerns about long follow-up.