Larynx and airway: bilateral abductor paralysis surgery: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Larynx and airway: bilateral abductor paralysis surgery

Sample item

A woman with bilateral vocal fold paralysis in the paramedian position has biphasic stridor and a normal voice. Which trade-off must be explained before a posterior cordotomy or arytenoidectomy to widen the glottis?

AA better voice at the cost of a narrower airwayBA better airway at the cost of a weaker, breathy voiceCCure of the paralysis with return of nerve functionDA better airway with no voice effect

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. A better airway at the cost of a weaker, breathy voice

Surgery that enlarges the posterior glottis improves the airway and may allow decannulation, but it allows air escape during phonation, so the voice becomes breathy and there is a risk of aspiration. Glottic width and voice quality trade against each other.

Option by option

A. A better voice at the cost of a narrower airway
This describes medialisation, which is used for unilateral paralysis and would worsen the airway in bilateral cases.
B. A better airway at the cost of a weaker, breathy voice (correct)
Correct. Widening the airway usually degrades voice quality and may cause aspiration.
C. Cure of the paralysis with return of nerve function
These operations do not restore nerve function.
D. A better airway with no voice effect
Enlarging the glottis allows air escape, so a voice effect is expected.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this ENT question

What is the answer to this ENT question?

The best answer is B, A better airway at the cost of a weaker, breathy voice. Surgery that enlarges the posterior glottis improves the airway and may allow decannulation, but it allows air escape during phonation, so the voice becomes breathy and there is a risk of aspiration.

Why is "A better voice at the cost of a narrower airway" not the answer?

This describes medialisation, which is used for unilateral paralysis and would worsen the airway in bilateral cases.

Why is "Cure of the paralysis with return of nerve function" not the answer?

These operations do not restore nerve function.

Why is "A better airway with no voice effect" not the answer?

Enlarging the glottis allows air escape, so a voice effect is expected.

What concept does this question test?

It tests Larynx and airway: bilateral abductor paralysis surgery in ENT. Glottic width and voice quality trade against each other.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Larynx and airway: bilateral abductor paralysis surgery?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.