The evaluation of unilateral vocal fold immobility: is chest X-ray enough?

Unilateral vocal fold immobility (UVFI) is a sign of underlying disease. No consensus exists regarding the appropriate evaluation. This study was performed to determine the ability of a chest radiograph (CXR) to limit further costly testing. The charts of 169 patients with previously undiagnosed UVFI were reviewed. In 113 patients the etiology was identified during the history and physical examination (H&P), or the H&P led to a directed evaluation. There were nine patients in whom the evaluation was incomplete. There were 47 patients in whom the etiology was not identified during the H&P. In 28 patients, the CXR identified the etiology, and in 16 cases the CXR ruled out an intrathoracic cause. There were three patients whose H&P and CXR did not identify their cervical etiology No patients had a thoracic etiology that was not identified by CXR. An algorithm was developed: If H&P fail to determine the etiology or to direct the evaluation, CXR is performed and followed by appropriate evaluation if positive. A negative CXR is followed with computed tomography (CT) of the neck from the skull base to thoracic inlet for right-sided UVFI and to the aortic triangle for left-sided UVFI. Other diagnostic studies are directed by signs and symptoms. A chest CT is not recommended unless there is clinical suspicion of a pulmonary or thoracic process.