Changing etiology of vocal fold immobility

Hypothesis: Vocal fold immobility is a sign of underlying disease. When the etiology remains unclear, evaluation may become time consuming and costly, and directed work-up imperative. This study examined the hypothesis that the etiologies of vocal fold immobility are changing, with extralaryngeal malignancies and nonthyroidectomy surgical trauma having become more common causes. Methods: A retrospective review of consecutive patients with vocal fold immobility who had an adequate workup to determine the etiology. Results: Three hundred ninety-seven cases with a determined etiology were identified, yielding 280 unilateral and 117 bilateral immobilities. The largest single category in unilateral immobility was nonlaryngeal malignancy-69 patients (24.7%)-80% of which were pulmonary or mediastinal, followed by 67 patients (23.9%) with immobility secondary to surgical trauma. Thyroidectomy accounted for only 8.2%. The leading cause of bilateral immobility was surgical trauma-30 patients (25.7%)-21 (18%) of whom had thyroidectomy. Acute and chronic intubation injuries accounted for 21 unilateral (7.5%) and 18 bilateral (15.4%) cases. Conclusions: These data indicate a changing etiology of vocal fold immobility, with growing percentages of extralaryngeal malignancies and surgery-related injuries. These findings have implications for the timing and method of management based on anticipated outcome.