A patient with bilateral vocal cord palsy in adduction presents in the emergency. Immediate management is:

• A Cricothyrotomy followed by definitive tracheostomy
• B Reassurance and close monitoring; spontaneous recovery expected within 48 hours
• C Rigid bronchoscopy under general anaesthesia to assess the cords
• D Emergency tracheostomy under local anaesthesia to secure the airway ✓

Explanation

Bilateral vocal cord palsy with cords in adduction (paramedian position) causes severe inspiratory stridor and life-threatening airway compromise because neither cord can abduct. The immediate priority is securing the airway with emergency tracheostomy under local anaesthesia, as general anaesthesia may be hazardous before airway is controlled. Cricothyrotomy is a temporary measure. After airway is secured, the cause is investigated; definitive options include arytenoidectomy (endoscopic laser) or laterofixation procedures. Spontaneous recovery does not occur immediately in bilateral RLN palsy.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.