(1) To assess the prevalence of arytenoid asymmetry during adduction, and (2) to correlate arytenoid asymmetry with vocal symptoms.

The medical records and video recordings of 116 patients who presented to the voice clinic were reviewed for the presence of arytenoid asymmetry, as regards sharpening of the aryepiglottic fold angle and altered positioning of the cuneiform and corniculate cartilages.

There were 61 males and 55 females, with a mean age of 39 years and a standard deviation of 15 years. Almost one-third had a history of reflux, 25 per cent had a history of smoking and 9.6 per cent had a history of allergy. Hoarseness was the most common symptom, occurring in 42.2 per cent of patients, followed by vocal fatigue (25 per cent) and inability to project the voice. The most common type of asymmetry was corniculate asymmetry, present in 27.6 per cent of the cases and accounting for 74.39 per cent of cases. This was followed by cuneiform cartilage asymmetry, present in 15.5 per cent of cases. There was no correlation between arytenoid asymmetry and vocal symptoms, except for vocal fatigue (p = 0.038).

The prevalence of arytenoid asymmetry during adduction is common. The presence of vocal symptoms such as hoarseness, breathiness, inability to project the voice and straining does not generally seem to correlate with the prevalence of arytenoid asymmetry. However, subjects with vocal fatigue are more likely to have cuneiform asymmetry.

Although modern endoscopic laser techniques aim to avoid a permanent tracheostomy by augmenting the glottic aperture in cases of bilateral vocal fold palsy, loss of tissue from the posterior glottis risks compromising voice quality and swallowing function. The objective of this study was to describe our experience with bilateral transverse posterior cordotomy.

This was a retrospective analysis of functional outcomes in a series of consecutive patients undergoing a simple modification of the classical laser cordectomy procedure, which avoids tissue loss. The procedure was confined to the complete release of the vocal ligament from the arytenoid cartilage on both sides, while avoiding any significant loss of mucosa or cartilage.

Post-operative voice quality and quality of life were rated as good by most patients, which makes bilateral transverse cordotomy an attractive treatment option for bilateral vocal fold paralysis.

Bilateral transverse cordotomy is a reliable treatment option for patients with bilateral vocal fold paralysis, and aims to avoid the morbidity associated with a permanent tracheostomy.