Frequency of major causes of left vocal cord paralysis

To determine the frequency of different causes of left vocal cord paralysis in patients reporting in a tertiary care set up. Study Design: Descriptive cross sectional study. Place and Duration of Study: This study was conducted at Combined Military Hospital Rawalpindi from Jan 2008 till Jan 2013. Patients and Methods: A total of 74 diagnosed cases of left vocal cord paralysis who consented to participate and fulfilling the inclusion criteria were included in this study. All patients were diagnosed by indirect laryngoscopy supplemented by flexible nasopharyngosopy whenever required. After detailed history and physical examination every patient was investigated in a sequence till confirmation of any pathology or exclusion of any underlying factor. Sequence of investigations were X-ray chest PA view, Barium swallow, Ultrasound neck, CT scan with contrast from base of skull to diaphragm, FNAC whenever required, panendoscopy under general anesthesia and biopsy. Results: The commonest cause identified was malignancy in 20 cases (27%), followed by iatrogenic trauma 18 cases (24.3%), idiopathic 14 (18.9%), non surgical trauma 13 (17.5%) and miscellaneous causes that accounted for 9 cases (12.1%). Conclusion: Left vocal cord paralysis is a common entity in ENT practice with multiple etiologies. An extensive protocol for investigation is required. Protocol should include USG, CT scan from base of skull to diaphragm because malignancy is still the most frequent cause of left vocal cord paralysis. (author)