A patient develops stridor after 14 days of prolonged intubation. Both vocal cords appear immobile in the paramedian position. To distinguish bilateral vocal cord palsy from posterior glottic stenosis, the single most useful bedside finding is:
- A Presence of a weak cry
- B Degree of hoarseness compared with stridor
- C Passive mobility of the arytenoids on gentle palpation during microlaryngoscopy ✓
- D Response of the cords to deep inhalation
Correct answer: C. Passive mobility of the arytenoids on gentle palpation during microlaryngoscopy
Explanation
In posterior glottic stenosis the cricoarytenoid joints themselves are fixed by scar tissue, so the arytenoids cannot be moved passively even though the nerves are intact. In bilateral RLN palsy the joints remain mobile and the arytenoids can be gently displaced despite denervation. Laryngeal electromyography showing preserved motor unit potentials supports fixation over palsy. This distinction matters because stenosis needs dilatation or scar release, whereas palsy may recover spontaneously.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.