This allows the S-LP to make a judgment about the overall severity of the voice quality. The CAPE-V is used in a similar manner, rating of the dimensions of voice quality on a subjective scale from 0–100, and using this to determine an overall severity score.In the presence of neural lesions with unknown cause, a thorough ENT endoscopy with additional imaging techniques (computed tomography (CT) of the chest, particularly in the case of left-sided paralyses, and magnetic resonance imaging (MRI) of the neck including the base of the skull and the brain, ultrasound examination of the neck) are performed to exclude tumors along the laryngeal nerves. When tumor formation is suspected, parts of the hypopharynx and the upper esophagus and passive mobility of the arytenoid cartilage are endoscopically examined under anesthesia.Voice diagnostics are used to assess voice quality and vocal performance. Voice assessment is necessary to plan and estimate the success of a possible speech therapy. In incompletely or only partially healed paralyses, stroboscopic larynx examinations yield a type of slow motion picture to assess tension and fine mobility of the vocal folds during vocalization. Stroboscopy and voice assessment are important to establish an individual treatment plan to improve the voice. Breathing tests (spirometry, body plethysmography) are used to measure impairment of respiratory flow through the larynx, particularly in patients with bilateral paralysis.
The SLN  is responsible for sensory input to the vocal folds. Due to its variable nature, the progression of vocal fold paresis may fluctuate, so it may be characterized differently from one evaluation to the next. Fluctuating vocal fold paresis has been observed in neurodegenerative disorders like Guillain–Barré syndrome or myasthenia gravis.The posterior cricoarytenoid (PCA) is a muscle of the larynx that is responsible for pulling the vocal folds apart from one another. Vocal fold paresis describes the weakness of the PCA and an impairment to its functioning. Unilateral vocal fold paresis is the term used when there is damage to the RLN on one side of the body. In unilateral vocal fold paresis, there is a lack of nerve supply to one side of the vocal folds PCA muscle. This lack of nerve supply renders the arytenoid cartilage immobile. The RLN may be damaged during surgical procedures. The right RLN in particular, has a greater chance of being damaged during surgery due to its position in the neck. When both of the vocal folds PCA muscles lack a nerve supply, the term bilateral vocal fold paresis is used. With bilateral vocal fold paresis, a persons airway may become blocked as the muscles are unable to pull the vocal folds apart fully. Treatment
The treatment of vocal fold paralysis varies depending on its cause and main symptoms. For example, if laryngeal nerve paralysis is caused by a tumor, suitable therapy should be initiated.