Extralaryngeal causes of unilateral vocal cord paralysis: Aetiology and prognosis

Abstract

Introduction and methodology: Unilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases of the thorax, neck, skull, or systemic disease. The objective is to study the extralaryngeal aetiology of unilateral vocal cord paralysis, its prognosis, and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT ± evaluation by Neurology with brain MRI to establish the aetiology and were followed-up for at least 1 year.

Results: The most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumour (24.1%). Idiopathic paralysis was the cause in 15.5%. An association was obtained between sex and aetiology (P < .01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumour and idiopathic aetiology predominated in elderly patients; while surgical aetiology predominated in younger patients (P < .01). A total of 18.1% recovered vocal cord mobility. The female sex was related to recovery (P < .01). Tobacco and malignant aetiology were related to persistence (P < .01).

Conclusions: The first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause the condition, in many cases involving a diagnosis of malignant tumours. Recovery is more frequent in female patients, non-smokers and with benign pathology.

Keywords: Cuerda vocal; Iatrogenesis; Nervio recurrente; Paralysis; Parálisis; Recurrent nerve; Unilateral; Vocal cord; Yatrogenia.