Hoarseness & Choking

Case Repost:

A 35-year-old woman complains of a 2-month history of hoarseness of her voice and some choking while drinking liquids. She denies viral illnesses. She underwent surgery for a cold nodule of the thyroid gland 9 weeks previously. Her only medication is acetaminophen with codeine.
CASE Questions

• What is the most likely diagnosis?
• What is the anatomical explanation for her symptoms?


ANSWERS TO CASE : Recurrent Laryngeal Nerve Injury

Summary: A 35-year-old woman has a 2-month history of voice hoarseness and choking after undergoing surgery for a cold (nonfunctioning) thyroid nodule.
• Most likely diagnosis: Injury to the recurrent laryngeal nerve.

• Anatomical explanation for her symptoms: Vocal cord paralysis.


• The right recurrent nerve is located more laterally than the left recurrent nerve because of the course of the subclavian artery.
• The posterior cricoarytenoids are the only muscles to abduct the vocal folds and are necessary to widen the rima glottidis for breathing.