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Objective: The prevalence of exercise-induced laryngeal obstruction is largely unknown. This study aimed to evaluate the prevalence of this condition in a selected study population of patients with exercise-induced dyspnoea., Method: A retrospective analysis was conducted of demographic data, co-morbidities, medication, symptoms, performance level of sporting activities, continuous laryngoscopy exercise test results and subsequent treatment., Results: Data from 184 patients were analysed. The overall prevalence of exercise-induced laryngeal obstruction in the study population was 40 per cent, and the highest prevalence was among females aged under 18 years (61 per cent). However, a high prevalence among males aged under 18 years (50 per cent) and among adults regardless of gender (34 per cent) was also found., Conclusion: The prevalence of exercise-induced laryngeal obstruction is clinically relevant regardless of age and gender. Clinicians are encouraged to consider exercise-induced laryngeal obstruction as a possible diagnosis in patients suffering from exercise-induced respiratory symptoms. No single characteristic that can distinguish exercise-induced laryngeal obstruction from other similar conditions was identified.

Objectives: This study investigates vocal outcome after cordectomy by transoral CO 2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy., Study Design: Prospective, longitudinal, quasi-experimental time series., Methods: Consecutively included patients (n = 155) with LIN (n = 84) or NNL (n = 71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings., Results: Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy., Conclusion: Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

This is a case report of a 54-year-old male, who developed a considerable tracheal stenosis after dilatational tracheotomy. Other causes than sequelae after tracheotomy were investigated and excluded. There are two types of tracheotomy: surgical and dilatational tracheotomy. Surgical tracheotomy is the preferred method in complicated cases, while dilational tracheotomy is easier accessible and has become increasingly prevalent. The objective of this case report is to highlight possible complications as well as advantages.

Background: The Voice Handicap Index 30 (VHI-30) is a much-used voice specific quality of life questionnaire. A shortened 10 item version has been developed by eliminating redundant items using item analyses. This is the first Danish translation of the VHI-10., Objectives: To evaluate the psychometric properties of the Danish VHI-10 questionnaire., Study Design: Cross-sectional survey study., Methods: A Danish translation of the VHI-10 was answered by 72 patients with voice disorders of different etiology (neurogenic, functional, and structural) and by a control group of 94 vocally healthy individuals. Thirty-two patients and 68 controls participated in a test-retest reliability analysis. The internal consistency, test-retest reliability, and clinical validity were assessed., Results: Excellent internal consistency was found in the patient group with a Cronbach's α of >0.90. In the control group the internal consistency was good with a Cronbach's α of 0.88. Test-retest reliability was good with intra class correlation coefficient of 0.94 (95% confidence interval [95%CI]: 0.88-0.97) for patients and 0.82 (95%CI: 0.73-0.89) for the control group. This indicates a sufficient reliability of the questionnaire. The correlation between the Danish VHI-10 score and the patient's perception of the severity of the voice disorder was 0.75 (P < 0.001) indicating good clinical validity of the Danish VHI-10., Conclusion: The newly translated Danish VHI-10 was validated and performs similar to the original VHI-10. It showed good internal consistency, test-retest reliability, and clinical validity. The questionnaire is preferably for use in patients with moderate to severe voice complaints as its ability to distinguish mild voice changes from healthy voices is limited. However, the questionnaire is capable of assessing patients' perception of the severity of their voice disorder and is available for use in daily practice and in research projects., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: Combined use of contact endoscopy (CE) and Narrow Band Imaging (NBI, Olympus ® ) is suggested for the visualization of specific vascular changes indicative of glottic neoplasia. We investigated the interrater reliability and agreement in 3 recognized classification systems of vascular changes applied to images from CE + NBI in patients suspected for glottic neoplasia., Methods: Six experienced head and neck surgeons familiar with NBI rated 120 images obtained by CE + NBI by 3 classification systems of vascular changes as suggested by Ni et al. (N-C), Puxeddu et al. (P-C), and the European Laryngological Society (ELS-C). Three raters were experienced in CE, and three raters had only limited experience with CE. Crude agreement and Fleiss' kappa with 95% confidence interval were estimated for all 6 raters, and for the 2 levels of expertise for each original classification system and for dichotomized versions of the N-C and the P-C based on suggested neoplastic potential., Results: The interrater crude agreement and the corresponding kappa values for the ELS-C were good and significantly higher than those for the N-C and P-C for all raters, irrespective of the level of experience with CE (p < 0.0001). There were no significant differences between the N-C and the P-C (p = 0.16). Kappa was considerably improved for both the N-C and the P-C to a level not different from the ELS-C (p = 0.21-0.71) when their 5 original categories were pooled into dichotomized classifications., Conclusion: Difficulties in reliably classifying vascular changes in CE + NBI are evident. Two-tier classification systems are the most reliable.

Objectives: Glottic precursor lesion (GPL) is a well-known premalignant condition, but the existing knowledge of incidence and malignant potential is based on subpopulation studies. In this first, nationwide study we report data from all verified cases of GPL in Denmark during a 10-year period with focus on incidence and malignant transformation of GPL. Methods: Patients were identified by a search for GPL in the time period from 01.01.2000 to 31.12.2009 using the Danish Pathology Data Base, Patobank, which is a nationwide source of all cyto- and histopathological data obtained in Denmark. Data were validated and supplemented by medical chart review. Results: A 10-year national cohort of 965 patients (median age 60 years, male-female ratio 2:1) with histologically verified GPL was analyzed. The overall malignant transformation rate was 18.3% (mild dysplasia 7.7%, moderate dysplasia 19.8%, severe dysplasia 28.5%, and carcinoma in situ 40.3%) with a median progression time of 29 months. Eighty-eight percent of patients were active or former smokers. A significantly larger proportion of male patients (24.1%) experienced malignant transformation compared to females (6.6%) ( p  < .001). Conclusion: This nationwide population-based study of GPL patients confirmed a stable incidence of GPL in Denmark from January 2000 to December 2009 and a considerable malignant potential, correlated to the grading of GPL according to the World Health Organization classification of laryngeal precursor lesions from 2005, WHOC2005. The recent update, WHOC2017, of low-grade versus high-grade lesions may thus contain less nuanced prognostic information than WHOC2005. Level of evidence: 2b retrospective cohort study.

Purpose: To evaluate the individual and combined ability of videostroboscopy (VS), high-speed digital imaging (HSDI), enhanced endoscopy (EE) and saline infusion (SI) to predict neoplasia, defined as glottic precursor lesion (GPL) or T1a glottic cancer, in patients suspected for glottic neoplasia., Methods: A nationwide prospective cohort study of patients treated by cordectomy for suspected GPL or T1a glottic cancer from August 1st 2016 to October 31st 2018 was conducted in the five Danish University Departments of Head and Neck surgery. Sensitivity, specificity, negative and positive predictive values, and area under Receiver Operating Curves (AUC-ROC) were calculated with 95% confidence intervals with respect to the histological diagnosis. Logistic regression with an imputation model for missing data was applied., Results: 261 patients aged 34-91 years participated; 79 (30.3%) with non-neoplasia (i.e., inflammation, papilloma, hyperkeratosis) and 182 (69.7%) neoplasia, hereof 95 (36.4%) with GPL and 87 (33.3%) with T1a glottic cancer. Data from 188 VS, 60 HSDI, 100 preoperative EE, 209 intraoperative EE, and 234 SI were analyzed. In the complete case analysis the AUC-ROC of each diagnostic test was low, but increased when the tests were combined and especially if the combination included EE. However, multinomial logistic regression with imputation showed significant association (p < 0.05) only between age, male gender, and perpendicular vasculature in intraoperative EE, and the endpoint neoplasia., Conclusions: Intraoperative EE was the most accurate diagnostic method in detecting neoplasia. The prediction ability of methods applied preoperatively was more limited, but improved when test modalities were combined.

Objective: To investigate the impact of postoperative paresis on disease-specific quality of life (DSQoL) after thyroidectomy in patients with benign nodular thyroid disease., Study Design: Observational study., Setting: University hospital., Subjects and Methods: Patients were evaluated before and 3 weeks and 6 months after surgery in an individual prospective cohort study using videolaryngostroboscopy (VLS), voice range profile, voice handicap index (VHI), multidimensional voice program, maximum phonation time (MPT), and auditory perceptual evaluation. Changes in DSQoL were assessed by the Thyroid-specific Patient-Reported Outcome measure. Cohen's effect size was used to evaluate changes., Results: Sixty-two patients were included, 55 of whom completed all examinations. Three weeks after surgery, a blinded VLS examination showed signs of paresis of either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve (RLN/EBSLN) in 13 patients (24%). A paresis corresponded to a 12 ± 28 point increase in VHI ( P = .002) and was associated with a significant 4.3 ± 7.5 semitone decrease in the maximum fundamental frequency ( P < .001) and a 5.3 ± 8.2 dB reduction in maximum intensity. Further, it was associated with a 4.5 ± 11.2 second reduction in MPT ( P = .001) and an increase of 0.40 ± 1.19 in grade, 0.42 ± 1.41 in roughness, and 0.36 ± 1.11 in breathiness. Signs of postoperative RLN/EBSLN paresis correlated with an 11.0-point ( P = .02) poorer improvement in goiter symptoms at both 3 weeks and 6 months after surgery., Conclusion: Signs of RLN/EBSLN paresis after thyroidectomy were associated with less pronounced improvement in goiter symptoms in patients with thyroid nodular disease. However, thyroidectomy was associated with an overall improved DSQoL by 6 months after surgery.

Background: The pediatric voice handicap index (pVHI) questionnaire was developed in 2006 to provide parental information regarding the impact of a voice disorder on their child's life., Objectives: The aim of this study was to make a Danish version of the original American pVHI and to validate the Danish pVHI by evaluating its internal consistency and reliability., Materials and Methods: The original version of the pVHI was translated into Danish. Nineteen parents of dysphonic children, diagnosed in a tertiary otolaryngology hospital department, and 43 parents of children without known voice disorder (control group) completed the questionnaire. The internal consistency, content validity including comparisons of the scores in the two groups and the test-retest reliability were assessed through statistical analysis., Results: The total pVHI scores significantly differed between the group of parents with dysphonic children and the group of parents with children without known voice disorder (p < 0.001). The internal consistency showed an excellent consistency (Chronbach's α > 0.9) of the three subdomains score and the total pVHI score. The test-re-test reliability of the total pVHI score was "strong" with a Pearson's correlation coefficient of 0.97., Conclusions and Significance: The Danish pVHI is a valid and reliable instrument to assess the parents' perception of the impact of a voice disorder on a child's physical, social and emotional well-being., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: We aimed to assess psychometric properties, including internal consistency, reliability, and clinical validity of the Danish version of the Voice Handicap Index (VHI)., Study Design: A cross-sectional survey study was carried out., Methods: For validation, the existing nonvalidated Danish version of the VHI was used. Data from 208 patients with voice disorders of different etiology (neurogenic, functional, and structural) and a control group of 85 vocally healthy individuals were included. A test-retest reliability analysis of 42 patients and 45 control persons was performed. The internal consistency, test-retest reliability, and clinical validity of the questionnaire were assessed., Results: Internal consistency was high with a Cronbach α >0.90 for both the patient and control group. Test-retest reliability measured as intraclass correlation coefficient was good with 0.93 (95% confidence interval [95% confidence interval]: 0.87-0.96) for patients and 0.78 (95% confidence interval: 0.63-0.87) for the control group which indicates sufficient reliability of the questionnaire. The Danish VHI has good clinical validity as it has a strong correlation between patient's perception of the severity of their voice disorder and the VHI score from the Spearman correlation of 0.69., Conclusion: The existing Danish version of the VHI has been thoroughly validated and found to be in line with the original VHI from Jacobsen et al. It showed good internal consistency, test-retest reliability, and clinical validity. It is suitable for use in daily practice and in research projects as it is able to assess patients' perception of their voice disorder severity., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Recurrent respiratory papillomatosis is a benign condition caused by human papillomavirus (HPV). Surgery is the mainstay of treatment, but numerous adjuvant therapies have been applied to improve surgical outcome. Recently, HPV vaccination has been introduced, but only smaller studies of its effect have been published. The present meta-analysis is intended as a possible substitute for a proposed but not yet realized multicenter randomized controlled trial., Methods: A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. PubMed, Embase, and Cochrane were systematically searched. All retrieved studies (n = 593) were reviewed and qualitatively assessed. In addition, 2 previously unpublished data sets were included. The systematic review included 11 studies, comprising 133 patients, of whom 63 patients from 5 studies were eligible for meta-analysis. A random-effects meta-analysis was conducted for the mean difference in number of surgical procedures per month before and after vaccination., Results: The number of surgical procedures per month was significantly reduced after HPV vaccination compared with before vaccination (estimated mean, 0.06 vs 0.35). The mean intersurgical interval increased from 7.02 months (range, 0.30-45 months) before to 34.45 months (2.71-82 months) after HPV vaccination., Conclusion: The present study supports the continued use of the HPV vaccine as an adjuvant treatment for recurrent respiratory papillomatosis., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Objective: The World Health Organization classification (WHOC) 2017 of low-grade versus high-grade laryngeal dysplasia recently replaced the previous WHOC 2005 of mild, moderate, and severe dysplasia and carcinoma in situ. Our objectives were to compare the interrater agreement of the WHOC 2017 with that of the WHOC 2005 and to test the intra-rater agreement of the WHOC 2005., Methods: Two expert head and neck pathologists rated 211 tissue samples that were initially diagnosed with laryngeal precursor lesions. The samples were rated twice according to the WHOC 2005 and once according to the WHOC 2017; estimates of interrater and intrarater agreements were calculated with kappa statistics., Results: The crude intrarater agreements using the WHOC 2005 were 0.93 for rater 1 and 0.62 for rater 2. The corresponding unweighted kappa values were 0.90 (95% confidence interval [CI], 0.86-0.95) for rater 1 and 0.43 (95% CI, 0.35-0.54) for rater 2, whereas the standard linear weighted kappa values were 0.93 (95% CI, 0.90-0.97) for rater 1 and 0.60 (95% CI, 0.53-0.69) for rater 2. The crude interrater agreement for the WHOC 2005 was 0.57, with a corresponding unweighted kappa value 0.38 (95% CI, 0.31-0.48) and a standard linear weighted kappa value 0.52 (95% CI, 0.42-0.60). The crude interrater agreement for the WHOC 2017 was 0.83, with a corresponding unweighted kappa value 0.45 (95% CI, 0.31-0.59) and a standard linear weighted kappa value 0.46 (95% CI, 0.30-0.60)., Conclusion: Our results indicate difficulties in providing reliable diagnosis of laryngeal precursor lesions, even with experienced head and neck pathologists and the application of a newly revised classification system., Level of Evidence: 4. Laryngoscope, 128:2375-2379, 2018., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

The formation of nontemplated (N) regions during Ig gene rearrangement is a major contributor to Ab diversity. To gain insights into the mechanisms behind this, we studied the nucleotide composition of N regions within 29,962 unique human V H DJ H rearrangements and 8728 unique human DJ H rearrangements containing exactly one identifiable D gene segment and thus two N regions, N1 and N2. We found a distinct decreasing content of cytosine (C) and increasing content of guanine (G) across each N region, suggesting that N regions are typically generated by concatenation of two 3' overhangs synthesized by addition of nucleoside triphosphates with a preference for dCTP. This challenges the general assumption that the terminal deoxynucleotidyl transferase favors dGTP in vivo. Furthermore, we found that the G and C gradients depended strongly on whether the germline gene segments were trimmed or not. Our data show that C-enriched N addition preferentially happens at trimmed 3' ends of V H , D, and J H gene segments, indicating a dependency of the transferase mechanism upon the nuclease mechanism., (Copyright © 2018 by The American Association of Immunologists, Inc.)

Childhood apraxia of speech and oral dyspraxia are subtypes of dyspraxia: a neurological motor disorder with absence of neuromuscular deficits. The core impairment is in planning and/or programming spatiotemporal parameters of movement sequences, which results in errors in speech sound production and prosody, or in oral motor movements and gestures. Correct diagnostics and focus on differential diagnoses and co-morbidity are crucial, as treatment differs from other types of speech- and oral motor disorders. Early and specialized intervention is recommended.

Objectives: The Ni classification of vascular change from 2011 is well documented for evaluating pharyngeal and laryngeal lesions, primarily focusing on cancer. In the planning of surgery it may be more relevant to differentiate neoplasia from non-neoplasia. We aimed to evaluate the ability of the Ni classification to predict laryngeal or hypopharyngeal neoplasia and to investigate if a changed cutoff value would support the recent European Laryngological Society (ELS) proposal of perpendicular vascular changes as indicative of neoplasia., Data Sources: PubMed, Embase, Cochrane, and Scopus databases., Review Methods: A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We systematically searched for publications from 2011 until 2016. All retrieved studies were reviewed and qualitatively assessed. The pooled sensitivity and specificity of the Ni classification with two different cutoffs were calculated, and bubble and summary receiver operating characteristics plots were created., Results: The combined sensitivity of five studies (n = 687) with Ni type IV-V defined as test-positive was 0.89 (95% confidence interval [CI]: 0.76-0.95), and specificity was 0.82 (95% CI: 0.72-0.89). The equivalent combined sensitivity of four studies (n = 624) with Ni type V defined as test-positive was 0.82 (95% CI: 0.75-0.87), and specificity was 0.93 (95% CI: 0.82-0.97)., Conclusions: The diagnostic accuracy of the Ni classification in predicting neoplasia was high, without significant difference between the two analyzed cutoff values. Implementation of the proposed ELS classification of vascular changes seems reasonable from a clinical perspective, with comparable accuracy. Attention must be drawn to the accompanying risk of exposing patients to unnecessary surgery. Laryngoscope, 128:168-176, 2018., (© 2017 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Correct assessment of patients with a glottic lesion is crucial for ensuring proper treatment in cases of cancer or premalignancy and for avoiding unnecessary surgery. For years, videostroboscopy (VS) has been the gold standard for assessing such lesions, but diagnostic difficulties have been described. We aim to estimate the diagnostic accuracy of VS in differentiating early glottic cancer from noninvasive lesions by conducting a systematic review and meta-analysis of published studies., Data Sources: PubMed and Embase databases were searched without restrictions on publication date., Review Methods: A systematic review and subsequent meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We systematically searched the literature for publications on stroboscopic diagnosis of cancer or premalignant lesions on the vocal cords. All retrieved studies were reviewed and qualitatively assessed. The pooled sensitivity and specificity of VS were calculated, and bubble and summary receiver operating characteristics plots were created., Results: A meta-analysis was conducted on five studies with a total of 307 patients. The sensitivities of VS within the single studies ranged from 86% to 100% and specificities ranged from 7% to 93%. The meta-analysis showed that the sensitivity of the combined results was 0.96 (95% confidence interval [CI]: 0.89-0.98), and the specificity was 0.65 (95% CI: 0.21-0.93)., Conclusion: VS is able to identify almost all patients with cancer, but only approximately two-thirds of patients with noninvasive lesions are correctly identified as not having cancer. Further research concerning assessment of patients with vocal cord lesions is needed., Level of Evidence: NA Laryngoscope, 126:2079-2084, 2016., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Breathing difficulties during exertion may be caused by exercise-induced laryngeal obstruction (EILO). The diagnosis depends on visualization of the larynx during exercise, i.e. by continuous laryngoscopic exercise (CLE) test. In case of severe supraglottic collapse and pronounced symptoms during strenuous exertion, surgical treatment (supraglottoplasty) has been suggested. The aims of this study were to evaluate outcome and patient satisfaction after supraglottoplasty for EILO and to compare our results with previously reported data. During the period December 2010 to October 2013, 17 patients diagnosed with moderate to severe supraglottic EILO were treated by supraglottoplasty with microlaryngoscopic laser technique at our institutions. The severity of patients symptoms (VAS score) and CLE scores was evaluated pre- and postoperatively. We found a decrease in patients symptoms from median 80 points VAS score preoperatively to 20 points postoperatively (p < 0.001) and a decrease in CLE sum score from median 4.0 points to 2.5 points (p < 0.05). Several previous studies have recommended surgery for selected patients with supraglottic involvement, but these have mainly been based on case reports or on very few patients. This study is the second larger-scale study that documents the positive effect of supraglottoplasty as treatment of EILO in terms of reduced respiratory symptoms and decreased laryngeal obstruction assessed by post-operative CLE test. We suggest that surgery is a well-tolerated and effective treatment option for selected EILO patients with moderate to severe supraglottic obstruction during exercise and a high level of physical activity.

Introduction: A new protocol for investigation of vocal fold palsy (VFP) was introduced in the ENT-department, Odense University Hospital on 1 January 2002. The protocol included ultrasonography (US) of the neck, x-ray of the chest and clinical examination at 3-month intervals for 1 year as well as MRI scanning of the brainstem, neck and mediastinum initially and after 6 months (or CT scanning under special circumstances). We have evaluated our protocol for investigation and in particular with regard to efficiency of diagnostic methods and the effect of long-term follow-up., Material and Methods: From 1 January 2002 to 30 June 2002 we investigated 48 patients with VFP of occult origin in our department. We reviewed medical records and registered and analyzed data regarding efficiency of diagnostic methods and the effect of follow-up., Results: Ten out of 48 VFP (21%) proved to be caused by malignancy. Eight VFP had other causes and 30 were idiopathic. Nine out of ten malignant diseases were found during initial investigation. One patient was diagnosed with breast cancer and widespread metastases 10 months after initial investigation., Conclusion: An extensive protocol for investigation of VFP is indicated. In our opinion, a protocol should include US, CT or MRI scanning of brainstem, neck and mediastinum. Our material is too limited to draw any final conclusions concerning long-term follow-up.

Introduction: The etiology of vocal fold palsy (VFP) is varied, and both Danish and foreign studies report variable frequencies of causes. We have evaluated etiologies of both unilateral (UVFP) and bilateral palsy (BVFP) and also analyzed the outcome of the palsies. As far as we know, our material is the largest published in Danish., Material and Methods: From 01.01.2000 to 30.06.2004 229 patients with VFP were evaluated in the ENT department of Odense University Hospital. We reviewed medical records and registered and analyzed data regarding etiology and outcome., Results: Trauma caused 39% of all cases and was thereby the most common etiology of VFP. 27% of the cases were idiopathic. Cancer caused 22% of all cases, most frequent for left-sided UVFP, but also a substantial number of right-sided and bilateral cases were due to malignancy. Neurological disease caused 18% of BVFP but only 1% of UVFP. The outcome of the palsy depended on the etiology. VFP caused by malignancy only rarely recovered. Chances of recovery were greatest for idiopathic VFP or palsy caused by neurological disease, but also a large proportion of traumatic VFP recovered., Conclusion: In a large patient population from Funen we found that trauma was the most common cause of VFP. Malignancy also frequently caused VFP. The outcome depended on the etiology. This is important when informing patients.