Computed tomography has low yield in the evaluation of idiopathic unilateral true vocal fold paresis.

OBJECTIVE/HYPOTHESIS To determine the clinical yield of neck and chest computed tomography in the initial assessment of patients with idiopathic unilateral true vocal fold paresis. STUDY DESIGN Retrospective chart review. METHODS A retrospective chart review of consecutive adult patients with idiopathic unilateral true vocal fold paresis diagnosed by stroboscopy in a tertiary-care voice center from 2003 to 2010. RESULTS There were 176 patients with unilateral vocal fold paresis of which 81 subjects had idiopathic unilateral true vocal fold paresis. Of these, 60 patients (74.1%) had a computed tomography workup. Fifty-nine patients (98.3%) had a normal computed tomography while one patient had a single mediastinal lymph node that was PET-CT negative. This demonstrates an initial 1.7% yield and ultimate 0% yield of the computed tomography workup. CONCLUSION Our results suggest that computed tomography workup has a low yield for occult neck and mediastinal pathology in patients with idiopathic unilateral true vocal fold paresis. Chest and neck computed tomography may not be clinically beneficial provided the patient has good otolaryngologic and medical follow-up.