FRCS (ORL-HNS) · SECTION 1 SBA

Posterior glottic stenosis

A patient remains unable to decannulate after prolonged intubation. Both vocal folds appear immobile, but laryngeal electromyography shows preserved motor units. What diagnosis should be suspected?

CHOOSE ONE ANSWER

Best of five

  1. A. Bilateral vagal transection
  2. B. Posterior glottic stenosis with cricoarytenoid fixation
  3. C. Spasmodic dysphonia
  4. D. Laryngomalacia
  5. E. Muscle-tension dysphonia
ANSWER AND REASONING

B. Posterior glottic stenosis with cricoarytenoid fixation

Prolonged intubation can scar the posterior commissure and mimic bilateral recurrent-laryngeal-nerve palsy. Preserved neural activity supports mechanical fixation; examination under anaesthesia clarifies the joints and scar.

Why every option is right or wrong

A. Bilateral vagal transection: Preserved motor units argue against complete denervation.

B. Posterior glottic stenosis with cricoarytenoid fixation: Prolonged intubation can scar the posterior commissure and mimic bilateral recurrent-laryngeal-nerve palsy. Preserved neural activity supports mechanical fixation; examination under anaesthesia clarifies the joints and scar.

C. Spasmodic dysphonia: This causes task-specific voice breaks, not fixed immobility.

D. Laryngomalacia: This is dynamic supraglottic collapse, usually in infancy.

E. Muscle-tension dysphonia: Supraglottic tension does not prevent decannulation through fixed joints.

What if the scenario changed?

If electromyography demonstrated bilateral denervation after skull-base surgery, neurogenic paralysis would be more likely.

EDUCATIONAL USE

Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.

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