A 20 year old singer reports inability to raise the pitch of her voice post-surgery. What is the likely diagnosis?

The scenario describes a young singer who is having difficulty raising the pitch of her voice following surgery, which indicates a potential issue with the nerves involved in voice modulation. The correct answer is external laryngeal nerve injury.

The external laryngeal nerve is a branch of the superior laryngeal nerve and innervates the cricothyroid muscle, which is crucial for adjusting the tension of the vocal cords and thereby influencing pitch. An injury to this nerve would lead to reduced ability to tense the vocal cords, resulting in a limited range of vocal pitch, particularly making it difficult to sing higher notes.

In contrast, injuries to the recurrent laryngeal nerve (both unilateral and bilateral) primarily affect the intrinsic muscles of the larynx that are responsible for managing voice quality and volume, rather than pitch. A unilateral injury might lead to hoarseness or a weak voice, but not specifically to an inability to raise pitch. Bilateral injury would more severely impair voice production, often leading to stridor and vocal cord paralysis, but again, it is not specifically limited to pitch issues.

Thyroid storm, which is a life-threatening hyperthyroid state, would not typically be associated with voice changes from a surgical intervention