Diagnostic yield of computed tomography in the evaluation of unilateral vocal fold palsy

There is a paucity of Asian-based data regarding the diagnostic yield of computed tomography imaging in the initial assessment of idiopathic unilateral vocal fold palsy. To investigate the diagnostic yield of computed tomography in idiopathic unilateral vocal fold palsy cases in an Asian tertiary hospital, and to determine the causative pathologies and positive predictive factors. A retrospective chart review was conducted of patients (between 2010 and 2018) with a clinical diagnosis of idiopathic unilateral vocal fold palsy who underwent contrast-enhanced computed tomography of the neck and chest at Tan Tock Seng Hospital, Singapore. The overall computed tomography diagnostic yield was 21 per cent, with malignancy accounting for 63.6 per cent of diagnoses. Degree of vocal fold weakness was the only significant predictor of positive computed tomography findings (11.5 per cent in vocal fold paresis vs 29.1 per cent in vocal fold paralysis, p = 0.025). None of the patients with negative computed tomography findings went on to develop disease after a mean follow up of 14.3 months. Computed tomography is a useful initial investigation for idiopathic unilateral vocal fold palsy, particularly in cases with vocal fold paralysis.