Vagal paragangliomas are anatomically specific tumors of neuroectodermal origin. The history, embryology, and anatomic classification of these tumors will be reviewed and our present experience with six patients with vagal paragangliomas summarized. All patients had vocal cord dysfunction; various other findings depended upon the extent of the tumor. We found that massive tumors extending rostral to the jugular fossa may be difficult or impossible to distinguish from jugulotympanic paragangliomas.