. A practical treatise on medical diagnosis for students and physicians . in Paralysis of the thyro-arytenoideus internus phonation. (Gottstein.) in phonation. (Gottstein.) Sometimes the arytenoideus transversus alone is affected. Then thereis hoarseness or aphonia. The anterior portions of the cords come togetherin phonation, but the posterior portions do not, leaving a triangular open-ing posteriorly. (See Fig. 341.) In other cases the thyro-arytenoideusinternus alone is affected. There is then dysphonia or aphonia, as before,but the cords come together at both extremities and remain apart i
. A practical treatise on medical diagnosis for students and physicians . in Paralysis of the thyro-arytenoideus internus phonation. (Gottstein.) in phonation. (Gottstein.) Sometimes the arytenoideus transversus alone is affected. Then thereis hoarseness or aphonia. The anterior portions of the cords come togetherin phonation, but the posterior portions do not, leaving a triangular open-ing posteriorly. (See Fig. 341.) In other cases the thyro-arytenoideusinternus alone is affected. There is then dysphonia or aphonia, as before,but the cords come together at both extremities and remain apart in themiddle, forming an oval opening. (See Fig. 342.) BILATERAL LARYNGEAL PARALYSIS. 871 Causal Disease. These paralyses occur in hysteria, catarrh, orsevere over-strain of the voice. 3. Paralysis of the Openers of the Glottis, or Abductors of theCords. The muscle affected is the crico-arytenoideus posticus ; the nerveis the recurrent laryngeal. Symptoms. When one side is affected, the respiration is free, but thereis stridor or forced inspiration. The voice is Paralysis of the left recurrent nerve ; Inspiration. (Gottstein.) Laryngeal Examination. One cord remains in the median line.(See Fig. 343.) When both sides are affected, inspiratory dyspnoea withstridor gradually develops. The voice is nearly normal. The glottisforms a narrow cleft which becomes still narrower on inspection. 4. Complete Paralysis of the Recurrent Laryngeal Paralysis. A weak, toneless voice which breaks into a fal-setto when the patient endeavors to speak loud. Laryngeal Examination. The cord and arytenoid body are inthe cadaveric position, viz., half-way between the phonating and theinspiratory positions. In phonation the other cord passes beyond themedian line, and the glottis is slanting. The edge of the paralyzed cordis excavated. Bilateral Paralysis. Aphonia and inability to cough and expectorate. Laryngeal Examination. Both cords are in the cadaveric positionand their edges
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