SEAN C. COLEMAN, MD; JAMES L. NETTERVILLE, MD; ROBERT H. OSSOFF, DMD, MD; MARK S. COUREY, MD; CHERYL BILLANTE, PHD

NASHVILLE, TENNESSEE

Recent studies suggest that the cause of vocal fold paralysis (VEP) is changing; however, these studies are limited by size. Furthermore, little is known regarding the outcome of patients with untreated VFP. To better define VFP, we present our experience with 843 patients over 13 years. The major causes of unilateral VFP were idiopathic causes (22.8%), neck surgery (18.8%), chest disorders (14.3%), skull base surgery (13.0%), thyroid surgery (12.4%), and trauma (9.2%); and of bilateral VFP, trauma (24.2%), idiopathic causes (23.2%), thyroid surgery (23.0%), inflammatory causes (10.1%), and chest disorders (5.1%). Furthermore, we document patient outcome with operative versus expectant management. Overall, 28% were treated nonoperatively. Cases of VFP from surgical trauma were managed differently with regard to the site of lesion. While only 6% of skull base lesions were treated non-operatively, 16% to 30% of distal lesions, 47% of idiopathic cases, and 61% of inflammatory cases were similarly managed. Therefore, knowledge of the VFP cause as it relates to outcome can guide patient management