Recurrent laryngeal nerve (RLN) palsy on the left side following thyroidectomy produces which voice quality change and which laryngoscopic finding?
- A High-pitched voice; ipsilateral vocal cord in abducted position
- B Breathy, weak voice; ipsilateral vocal cord in paramedian (cadaveric) position ✓
- C Voice unaffected; cord in fully adducted position
- D Strained voice; bilateral cord medialization
Correct answer: B. Breathy, weak voice; ipsilateral vocal cord in paramedian (cadaveric) position
Explanation
Unilateral RLN palsy paralyzes all intrinsic laryngeal muscles on that side except the cricothyroid (supplied by external branch of SLN). The paralyzed cord adopts a paramedian (near midline/cadaveric) position because the cricothyroid still provides some tension. The voice is breathy and weak because the paralyzed cord cannot fully adduct for phonation, resulting in glottic incompetence. Over time, compensatory adduction of the opposite cord may improve voice. Bilateral RLN palsy causes inspiratory stridor and respiratory distress.
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.