<p>(1) Identify, assess and evaluate incidental findings of Idiopathic unilateral vocal fold paresis on computed tomography scan. (2) To have early diagnosis and management in patients with Idiopathic unilateral vocal fold paresis. Prospective study of 25 patients in age group from 20 to 80&#xa0;years with a clinical diagnosis of idiopathic vocal fold paresis were evaluated. Multidetector CT scan, with a minimum section thickness of 3&#xa0;mm, covering the area from the skull base to the mediastinum was performed. 8 radiological indicators of vocal cord paresis were then assessed. A total of 9 of the 25 cases were female, and 16 were male. The most often affected age groups were the 5th and 6th decades. Left vocal fold were more affected than right. CT scan findings among 25 participants revealed that, in 22 cases (88%) ipsilateral pyriform sinus dilatation was seen. In 21 cases (84%), the vocal folds were in paramedian position. Similarly (84%) demonstrated medial rotation and thickening of the aryepiglottic fold. Ipsilateral laryngeal ventricle dilatation was noted in 18 patients (72%). The “mushroom sign” was present in 15 cases (60). Findings such as dilation of the ipsilateral pyriform sinus and vocal fold in paramedian position showed perfect 100% sensitivity. Similarly, Sail sign also showed 100% sensitivity. Dilatation of the ipsilateral laryngeal ventricle demonstrated a better balance with 83.33% sensitivity. Although laryngoscopy remains the gold standard, our study highlights that certain CT imaging signs can significantly aid in its identification especially in idiopathic cases or when laryngoscopy is delayed or unavailable. These signs, when incidentally noted on CT scans performed for unrelated indications, may prompt early suspicion and referral, leading to timely diagnosis and management.</p>