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–LCA – rotation medially of vocal process and consequently some adduction

–Watch respiration for range of motion (ROM) between inspiration and expiration

–Watch closure during adduction in slowed down motion for speed of closure and range of closure. Upper portion of arytenoid will cover part of view at end of closure, earlier if the PCA is out on the same side; low speed very valuable

–Topical anesthesia greatly enhances view of posterior commissure during phonation – best view

–Observe for triangle of lateralized vocal process on weak side. Be cognizant of hyperclosure from good cord’s vocal process

–Then view at lowest possible pitch

–Compare normal, symmetric posterior commissure with high, medium and low pitch posterior commissures