Abstract
Although the clinical significance of vocal fold paresis is generally acknowledged among specialists, details of evaluation and diagnosis remain highly debated. Many studies evaluating vocal fold paresis have been performed in the last two decades; most are retrospective and fraught with methodological concerns. Diagnosis and management of paresis remain founded primarily on experience and opinion with little high-quality evidence to support clinical practice. Universally agreed-upon standards for diagnosis remain elusive. Most laryngologists diagnose paresis by laryngoscopic or stroboscopic signs, despite acknowledged interrater inconsistencies. Laryngeal electromyography has the potential to be a valuable diagnostic adjunct, although not immune to similar concerns regarding interpretation. Diagnostic treatment trials offer a practical means to verify clinical impression. Treatment options are similar to those in vocal fold paralysis. Otolaryngologists should remain vigilant to identify paresis at the same time that they remain wary of casual overdiagnosis.
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