title: Vocal fold immobility: a longitudinal analysis of etiology over 20 years.
abstract: OBJECTIVE
  To determine the current etiology of vocal fold immobility, identify changing trends over the last 20 years, and compare results to historical reports.
  
  
  METHODS
  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.
authors: Department of Otolaryngology-Head and Neck Surgery, Henry Ford Medical Group, Detroit, Michigan, USA. lrosenthal@alumni.upenn.edu
authors: Laura H Swibel
authors: LH
authors: Rosenthal
authors: Michael S
authors: MS
authors: Benninger
authors: Robert H
authors: RH
authors: Deeb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*