The rate of occult lesions in unilateral vocal fold paralysis with unknown causes

This study retrospectively reviewed the medical charts of patients with unilateral vocal fold paralysis (UVFP) and investigated the yield rate of occult lesions along the recurrent laryngeal nerve (RLN) and the vagus nerve.

The diagnostic process started with a thorough history taking regarding preceding surgery, concurrent cancer, trauma or intubation history, and referred reports. Those with unknown causes received imaging studies. Patients with lesions along the course of the vagus and the RLN were defined as the occult group, while those without identified lesion were defined as the idiopathic group.

Among the 437 patients, 316 were of known causes. The remaining 121 patients of unknown causes received contrast-enhanced neck and chest CT scans (N = 117), or brain and neck MRIs (N = 4). Occult lesions were identified in 48 patients (39.7 %). Age of patients in the occult group (63.7 ± 11.1 years) was significant higher than those in the idiopathic group (54.0 ± 16. 6 years, p < 0.01); whereas occult group had shorter symptom duration than idiopathic group (4.47 ± 17.2 vs. 12.7 ± 24.5 months, p = 0.04). We also noticed a higher rate of smoking in the occult group (48 %), compared with idiopathic group (26 %, p = 0.01). When occult lesions were found, the malignancy rate is (87.1 %) was significantly higher in the chest than in the neck (43.8 %, p < 0.01).

This study revealed that UVFP of unknown causes account for 27.7 % of all incidences, while the yield rate of occult lesions was 39.6 %. Occult lesions were more common in older patients and smokers, while chest lesions were more likely to be malignant.