Bilateral vocal cord paralysis most commonly results in which position of the vocal cords, and what is the primary clinical consequence?

• A Abducted (cadaveric) position; severe breathlessness on exertion
• B Paramedian position; life-threatening biphasic stridor requiring airway intervention ✓
• C Adducted (phonatory) position; good voice but aspiration of liquids
• D Median position; aphonia with normal breathing

Explanation

In bilateral RLN palsy, the vocal cords assume the paramedian (slightly adducted) position because the cricothyroid (tensor, supplied by SLN) remains intact. This leaves a narrow glottic chink insufficient for comfortable breathing, causing biphasic stridor and respiratory distress, which can be life-threatening. Voice is relatively preserved (cords can approximate). Management requires tracheostomy as an emergency airway, followed by lateralisation procedures (arytenoidectomy, laser posterior cordectomy). Cadaveric (intermediate) position occurs with combined RLN + SLN 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.