Unilateral Vocal Cord Palsy: An Etiopathological Study

Abstract

ABSTRACT Objective The incidence of various causes of unilateral vocal cord palsy (UVCP) has been found to change over time and place. To arrive at the correct diagnosis is important in determining the prognosis as well as the time and mode of intervention. This study intends to evaluate the current etiological profile of unilateral vocal cord palsy in our center and compare it with the previous studies. Methods A retrospective study of case records of all consecutive patients with a diagnosis of UVCP presented to Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, South India in the period between September 2002 and May 2009 was conducted. The exclusion criteria were all laryngeal and hypopharyngeal malignancies, intubation injuries and cricoarytenoid joint ankylosis. Factors taken for analysis were age, gender, side of palsy and etiology. Results A total of 121 cases including 88 males and 33 females in the age range of 2 to 86 years were studied. 61.1% patients had left-sided palsy and 38.8% had right-sided palsy. The incidence of various etiologies were idiopathic (42.1%), surgical trauma (22.3%), nonsurgical trauma (6.61%), nonlaryngeal malignancy (6.61%), central (12.4%) and other benign lesions (9.09%). The incidence of all nonthyroidectomy surgeries together (59.3%) was more than that of thyroidectomy (40.7%). The most common individual surgical procedure was still thyroidectomy (11 cases, 40.7%) followed by coronary artery bypass grafting (CABG) (7 cases, 25.9%). Conclusion Idiopathic vocal cord palsy constituted the major subgroup. Thyroidectomy continues to be the single most common surgical procedure responsible for vocal cord palsy. Cardiac surgeries, trauma and cerebrovascular accidents are also increasingly causing vocal cord palsy, which is suggestive of the changing trend in life style and life expectancy. The right recurrent laryngeal nerve is not at higher risk than the left in thyroid surgery. Benign thyroid swellings also contribute significantly to UVCP.