Purpose of review: Recent papers on incidence of unilateral paresis in general and for specific causes; techniques to assist clinical diagnosis; computer and animal modeling leading to new assessment tools; and studies on the effectiveness of clinical management.

Recent findings: There is much interest in being able to assess unilateral paresis in patients both pre and post-thyroidectomy. Because the gold standard for defining the presence of paresis is by laryngeal electromyography, which is not routinely available, much interest has been placed in finding other measures that correlate with electromyographic findings, including use of ultrasound imaging and high-speed videoendoscopy. Paresis is also being seen as an underlying factor in other voice disorders, such as reflux and presence of granulomas. Animal modeling is providing insights into the mechanisms that will help our understanding of vocal fold asymmetry. The development of trial injections to determine if more permanent interventions will provide good outcomes is an important step in good patient care.

Summary: Randomized clinical trials need to be completed to provide level 1 evidence for the efficacy of treatments. Centers that have access to laryngeal electromyography need to lead the way in developing assessment tools and treatment trials for patients with paresis.