Vocal fold immobility: A longitudinal analysis of etiology over 20 years

Laura H Swibel Rosenthal*, Michael S. Benninger, Robert H. Deeb

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

260 Scopus citations


OBJECTIVES: To determine the current etiology of vocal fold immobility, identify changing trends over the last 20 years, and compare results to historical reports. STUDY DESIGN: The present study is a retrospective analysis of all patients seen within a tertiary care institution between 1996 and 2005 with vocal fold immobility. The results were combined with a previous study of patients within the same institution from 1985 through 1995. Results were compared to the literature. METHODS: The medical records of all patients assigned a primary or additional diagnostic code for vocal cord paralysis were obtained from the electronic database. RESULTS: Eight hundred twenty-seven patients were available for analysis (435 from the most recent cohort), which is substantially larger than any reported series to date. Vocal fold immobility was most commonly associated with a surgical procedure (37%). Nonthyroid surgeries (66%), such as anterior cervical approaches to the spine and carotid endarterectomies, have surpassed thyroid surgery (33%) as the most common iatrogenic causes. These data represent a change from historical figures in which extralaryngeal malignancies were considered the major cause of unilateral immobility. Thyroidectomy continues to cause the majority (80%) of iatrogenic bilateral vocal fold immobility and 30% of all bilateral immobility. CONCLUSIONS: This 20-year longitudinal assessment revealed that the etiology of unilateral vocal fold immobility has changed such that there has been a shift from extralaryngeal malignancies to nonthyroid surgical procedures as the major cause. Thyroid surgery remains the most common cause of bilateral vocal fold immobility.

Original languageEnglish (US)
Pages (from-to)1864-1870
Number of pages7
Issue number10
StatePublished - Oct 2007


  • Bilateral
  • Hoarseness
  • Unilateral
  • Vocal fold paralysis
  • Vocal fold paresis

ASJC Scopus subject areas

  • Otorhinolaryngology


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