Etiological profile of unilateral vocal cord paralysis: A single institutional experience over 10 years

Abstract

Objective: Unilateral vocal cord palsy is a major cause of dysphonia. With umpteen number of causes being attributed to it and changing trends in etiology from place-to-place and over time, it is of utmost importance to arrive at a correct diagnosis to plan further management and to determine the prognosis. The aim was to evaluate the etiological profile of unilateral vocal cord palsy in our institute that is a tertiary referral center over the past 10 years. Materials and Methods: Case records of all patients diagnosed with unilateral vocal cord palsy who presented to Deenanath Mangeshkar Hospital, Pune, Maharashtra, India between 2003 and 2013 were retrospectively reviewed. The exclusion criteria included patients with laryngeal/hypopharyngeal malignancies, intubation trauma, congenital vocal cord palsy and cricoarytenoid joint ankylosis. The age, gender, laterality and etiology were the factors taken into consideration. Results: A total of 277 cases spanning over the age range of 2 months to 98 years met our inclusion criteria, out of which 179 were males, and 98 were females with a male to female ratio being 1.82:1. In terms of laterality, 182 patients had left sided, and 95 had right sided vocal cord palsy. Majority of the cases were found to be in the fourth and fifth decades. The most common etiology was idiopathic 136 (49.1%). The incidence of various other etiologies were surgical trauma 60 (21.6%), nonsurgical trauma 10 (3.7%), nonlaryngeal malignancy 36 (12.9%), central/ neurological 17 (6.1%), postradiation 1 (0.3%), and other benign lesions 17 (6.1%). Among the surgical causes, the incidence of nonthyroidectomy surgeries (58.3%) was more than that of thyroidectomy (41.6%). Thyroidectomy was the single most common surgical cause for unilateral vocal cord palsy, followed by other nonthyroid neck surgeries (20%) and anterior cervical decompression (18.3%). Conclusion: The most common cause for unilateral vocal cord palsy is idiopathic. Nevertheless it is still an important sign of various underlying diseases. A thorough evaluation which must necessarily include a computerized tomographic scan from base of the skull to upper mediastinum is essential before labeling a case as idiopathic; hence, also the need for extended follow-up of the cases to avoid misdiagnosis of any underlying subclinical malignancy.

Atypical presentation of a posterior fossa tumour: A case report

“…Unilateral vocal cord paralysis can be asymptomatic or can present with hoarse voice, dysphonia, dysphagia, aspiration, and coughing[ 1 , 2 ]. Patients may recover spontaneously in some instances, or the contralateral cord may compensate for its dysfunctional counterpart[ 1 ]. The most commonly affected side for an isolated vocal cord paralysis is the left side, as was the case in our patient[ 1 ].…”

“…Patients may recover spontaneously in some instances, or the contralateral cord may compensate for its dysfunctional counterpart[ 1 ]. The most commonly affected side for an isolated vocal cord paralysis is the left side, as was the case in our patient[ 1 ]. This is due to the longer course of the left recurrent laryngeal nerve compared to the right side making it more vulnerable to damage, especially in the mediastinum.…”