Bilateral abductor vocal cord paralysis presents with which symptom pattern, and what is the immediate airway intervention?

• A Breathy, hoarse voice with no dyspnoea — reassure and observe
• B Expiratory stridor with wheezing — manage as bronchospasm
• C Severe inspiratory stridor with voice nearly normal (cords in midline) — tracheostomy may be required to secure airway ✓
• D Complete aphonia with no stridor — voice rehabilitation is the priority

Explanation

In bilateral abductor paralysis, both recurrent laryngeal nerves are affected, leaving the thyroarytenoid (adductor) muscles unopposed — the vocal cords lie in the paramedian/median position. The glottic chink is severely narrowed, producing inspiratory stridor (breathing is severely compromised) while paradoxically preserving a near-normal voice (cords are close together for phonation). This is a respiratory emergency; if stridor is severe and respiratory distress is present, urgent tracheostomy is required. Subsequent surgical management includes posterior cordotomy, arytenoidectomy, or laryngeal re-innervation.

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

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Written and medically reviewed by the StethoPrep medical team.