Changing etiology of vocal fold immobility

Hypothesis: 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.