Discussion
The correct diagnosis of a vocal cord movement abnormality is vital to help guide management of the patient, with potential medicolegal implications if misdiagnosed. There are many causes of abnormal movement, with movement ranging from fully mobile, paresis to complete paralysis. Ideally clinical assessment would result in a reliable five category scale to allow use in the range of clinical situations such as reduction in movement in early invasive cancer or post thyroid surgery. Although the present gold standard for assessing the movement of a vocal cord is flexible nasendoscopy, there are few published studies assessing the consistency between different raters.