Routine Computed Tomography in the Evaluation of Vocal Fold Movement Impairment without an Apparent Cause

• Published in: Otolaryngology-head and neck surgery 2015-02, Vol.152 (2), p.308-313
• Main Authors: Chen, Diane W., Young, Alex, Donovan, Donald T., Ongkasuwan, Julina
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; computed tomography; Female; Humans; idiopathic; Male; Middle Aged; Recurrent Laryngeal Nerve - diagnostic imaging; Retrospective Studies; Texas; Tomography, X-Ray Computed - methods; Vocal Cord Paralysis - diagnostic imaging; Vocal Cord Paralysis - etiology; vocal fold movement impairment; vocal fold paralysis
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599814562720

Objective Routine computed tomography (CT) for vocal fold movement impairment (VFMI) without an apparent cause is common. However, given increased cancer risk associated with ionizing radiation exposure, our purpose is to evaluate the utility of routine scans for these patients. Study Design Retrospective case series. Setting Houston, Texas. Subjects and Methods A 5-year review of patients with VFMI diagnosed at an academic institution was conducted. For patients without an apparent cause (eg, recent head, neck, or cardiothoracic surgery or known malignancy), CT head/neck and chest was performed to evaluate the recurrent laryngeal nerve course. Data included demographics, symptoms, radiography, and interventions. Statistical analyses were performed via χ2 analysis. Results Of 406 patients with VFMI, 47 (11%) patients had no apparent cause clinically. Routine CT revealed abnormalities in 10 (21%) patients, of which only 3 (6%) could account for VFMI: benign thyroid adenoma (1), papillary thyroid cancer (1), and an esophageal mass (1). The most common lesion detected involved the thyroid. Demographic data and symptom type were not significantly associated with detection of a VFMI-attributable lesion on CT. Overall, routine CT did not identify a focal etiology in 94% patients with VFMI without an apparent cause. Conclusion Routine pan-CT evaluation failed to reveal an etiology in 94% of patients with VFMI without an apparent cause. Patients may be subjected to health risks associated with radiation exposure without significant diagnostic benefit. Further studies should consider more judicious use of CT in the context of risk factors and safer imaging modalities as the initial diagnostic step.