Certified Registered Nurse Anesthetist (CRNA) Practice Exam

What is the cause of hoarseness after endotracheal intubation lasting more than 7 days?

1. Trauma to the vocal cords

2. Pressure of the endotracheal tube on the recurrent laryngeal nerve

3. Stimulation of the vagus nerve

4. Infection from the endotracheal tube

The correct answer is: Pressure of the endotracheal tube on the recurrent laryngeal nerve

Hoarseness that lasts more than seven days following endotracheal intubation is often attributed to pressure on the recurrent laryngeal nerve. This nerve innervates the muscles that control the vocal cords. If the endotracheal tube applies significant pressure on this nerve—especially in patients with prolonged intubation or those with anatomical variations—it can lead to vocal cord dysfunction, resulting in persistent hoarseness. While trauma to the vocal cords can lead to hoarseness, it is typically associated with more acute and immediate symptoms rather than lasting over a week. Infection may also occur with endotracheal intubation, but it is less common to cause prolonged hoarseness specifically due to the presence of an endotracheal tube. Stimulation of the vagus nerve can cause various reflexes, but it does not typically lead to long-term vocal cord changes. Therefore, prolonged pressure on the recurrent laryngeal nerve from the endotracheal tube serves as the primary mechanism for the observed hoarseness beyond the initial post-intubation period.