title: Changing etiology of vocal fold immobility.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan 48202-2689, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Benninger
authors.forename: J B
authors.initials: JB
authors.lastname: Gillen
authors.forename: J S
authors.initials: JS
authors.lastname: Altman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004576:Electromyography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D009626:Terminology as Topic; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000209:etiology*