Diagnostic Yield of Computed Tomography in Evaluation of Vocal Fold Paresis: Is It Worth It?

Abstract

Objectives: (1) Determine the diagnostic yield of contrast-enhanced computed tomography (CT) in the evaluation of patients with idiopathic unilateral vocal fold paresis. (2) Determine the proportion of CTs yielding nondiagnostic incidental findings requiring further patient management. Methods: Retrospective cohort. Precision-based power calculations were performed. All patients of the 2 senior authors who underwent contrast-enhanced CT for a clinical diagnosis of vocal fold paresis from January 2004 to January 2014 were included. Demographic, history, examination, and investigation data were extracted from outpatient records and CT reports were reviewed. Patients were excluded if there was insufficient history or examination information, if there was a known neurological diagnosis, or if there was vocal fold immobility or bilateral involvement. A diagnostic CT was defined as depicting a pathological lesion along the course of the ipsilateral recurrent or superior laryngeal nerves. Incidental CT findings were defined as those unrelated to paresis and requiring further intervention. Results: A total of 128 patients were included in the study. Three out of 128 patients had a diagnostic CT equating to a diagnostic yield of 2.3% (0.49-6.7 95% confidence interval [CI]). Thirty-nine out of 128 patients, or 30.5% (22.6-39.2 95% CI) had an incidental CT finding requiring further management. Conclusions: Contrast-enhanced CT has a low yield of 2.3% in the initial evaluation of idiopathic vocal fold paresis. Conversely, CT has a high, 30.5% yield of incidental cervico-thoracic lesions. This would suggest that the routine use of CT in the evaluation of idiopathic vocal fold paresis is not warranted.