Which of the following is often associated with underlying congenital cardiac anomalies?

• A. Congenital subglottic stenosis
• B. Laryngomalacia
• C. Congenital vocal cord paralysis
• D. Croup

Answer: (C)

The key idea is that the left recurrent laryngeal nerve, which controls movement of the vocal cords, travels in the mediastinum near the aortic arch and other mediastinal structures. In congenital heart disease or arch/mediastinal anomalies, this nerve can be compressed or stretched, leading to congenital vocal cord paralysis. This presents in newborns as a hoarse cry or weak voice and may include inspiratory symptoms if the airway is affected. That specific link to mediastinal and cardiac anatomy is why congenital vocal cord paralysis is the finding associated with underlying congenital cardiac anomalies. Subglottic stenosis, laryngomalacia, and croup are more related to airway caliber, developmental maturation, and infection, respectively, rather than underlying heart defects.