[Etiology and diagnostic methods in vocal cord paralysis]. / Aetiologi og diagnostiske metoder ved stemmebåndsparese.

INTRODUCTION: The etiology of vocal cord paralysis (VCP) is varied. There is lack of consensus regarding the choice of investigations to be used in the evaluation of VCP. The aim of this study was to establish the etiology, assess the diagnostic methods used in the evaluation, and outline an algorithm for future evaluation of unilateral vocal cord paralysis (UVCP). MATERIAL AND METHODS: Charts of all patients (n = 94) with the diagnostic code of VCP were reviewed, and reexaminations were performed of patients in whom no etiology was found after the initial symptoms. RESULTS: The etiology of UVCP was neoplasm in 34%, surgical trauma in 12%, and miscellaneous causes in 54%. The etiology of bilateral vocal cord paralysis (BVCP) was neoplasm in 24%, surgical trauma in 24%, and miscellaneous causes in 52%. The reexaminations did not reveal any cancer diseases in the patients concerned. The most effective diagnostic method was CT-scanning while the least effective was thyroid scanning. DISCUSSION: Because cancer is a common cause of VCP a thorough evaluation is necessary. For UVCP we recommend history and physical examination, X-ray of the chest, ultrasonography of the neck, and CT-scanning of the superior mediastinum. If these prove negative, panendoscopy should be performed. Workup of patients with idiopathic VCP should include examination, X-ray of the chest at 6-month intervals, and annual CT-scanning for two years.