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Diagnoses of vocal fold paralysis, carcinoma, and vocal fold bowing were frequent, but occurred more often in elderly speakers.
For example, an occult vocal fold paralysis in a postado- lescent male or female may present as a high-pitched, breathy voice.
Some of these disorders are confined to voice and laryngeal manifestations, such as vocal fold paralysis, whereas broader progressive neurologic diseases may cause deterioration of many central and peripheral motor control systems, including impairment of respiration,
Vocal fold paralysis is the most common neurologic voice disorder, and is typically caused by peripheral involvement of the recurrent laryngeal nerve and, less commonly, of the superior laryngeal nerve.
There are many pos- sible etiologies of vocal fold paralysis, including surgical trauma, cardiovas- cular disease, neurologic diseases, and accidental trauma.3'13'94-96 Historically, estimates of idiopathic unilateral vocal fold paralysis have been as high as 30% to 35%,94 but two more recent reports of 117 and 159 patients each reported that idiopathic (unknown) etiologies were identified in unilateral vocal fold paralysis 16.3%87 and 23%96 of the time.
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