Laryngoscopic and Stroboscopic Signs in the Diagnosis of Vocal Fold Paresis

Thirty four laryngoscopic examinations were evaluated by 31 laryngologists from the presence or absence of paresis, side and which nerves were involved. Examinations for which more that 70% of the raters agreed had paresis were examined further. Findings underlying this judgement, in order from most to least compelling, were abnormalities in gross movement of the vocal fold; signs of degeneration like vocal fold atrophy or hypotonia; incomplete glottic closure; and abnormalities of mucosal wave vibration such as asymmetry or phase differences. Even within this group, there was disagreement regarding side of paresis and nerves involved. This study suggests that diagnosis of paresis by laryngoscopy and stroboscopy alone remains subjective, with considerable variation from physician to physician.