Six weeks after prolonged intubation, a patient has stridor and both vocal folds appear immobile near the midline. CT shows no compressive lesion along either recurrent laryngeal nerve. Which assessment best distinguishes posterior glottic stenosis from bilateral neurogenic paralysis?
Apparent bilateral vocal-fold immobility is a sign, not a mechanism; examination under anaesthesia with joint palpation plus EMG separates scar fixation from denervation and guides reconstruction.
A. Voice handicap index alone: Patient-reported voice impact cannot distinguish fixation from denervation.
B. Microlaryngoscopy with palpation of both cricoarytenoid joints, supported by laryngeal EMG: Joint fixation/interarytenoid scar is demonstrated mechanically, while EMG assesses neuromuscular recruitment and prognosis.
C. Repeat flexible laryngoscopy after topical decongestant: It reconfirms immobility but not its mechanical or neurogenic mechanism.
D. Empirical bilateral cordotomy before diagnosis: Ablative widening may irreversibly damage voice and aspiration protection without defining cause.
E. Barium swallow: This does not assess cricoarytenoid mobility or laryngeal motor units.
If both joints were mobile and EMG showed active denervation with no recovery potentials, a neurogenic airway-widening strategy would be considered.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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