COVID-19 Likely Paralyzes Vocal Cords in Teen, Say Doctors

Bilateral vocal cord paralysis requiring long-term tracheostomy after SARS-CoV-2 infection

Summary

Bilateral vocal cord paralysis can cause glottal airflow obstruction, leading to respiratory distress and the need for a surgical airway. We report a case of acute onset bilateral vocal fold paralysis in a healthy adolescent patient 9 days after a mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This 15-year-old patient presented with dyspnea, tachypnea, and stridor. Fiberoptic laryngoscopy revealed bilateral vocal cord paralysis with limited vocal cord abduction causing respiratory distress. A detailed set of diagnostic test results, including blood tests, imaging, and a lumbar puncture, were all negative , except for his new diagnosis of SARS-CoV-2 infection.

The patient underwent a tracheostomy with subsequent resolution of her symptoms. Her vocal cord function remains impaired and the patient remains dependent on tracheostomy 13 months after initial presentation. SARS-CoV-2 infection has multiple well-established neurological complications in children. The current case suggests that vocal cord paralysis may be an additional neuropathic sequelae of the virus. Vocal fold pathology should be an important consideration when constructing a differential for children who present with voice, swallowing, or breathing problems after SARS-CoV-2 infection.

Comments

COVID-19 appears to have paralyzed a teenage girl’s vocal cords, blocking her breathing to the point that surgery was necessary, according to a new report. The case suggests that vocal cord paralysis could be a rare complication of COVID infection, caused by the virus’s effect on the nervous system.

"Given how common this virus is among children, this newly recognized potential complication should be considered in any child who presents with problems breathing, speaking, or swallowing after a recent diagnosis of COVID-19," said lead researcher Dr. Danielle Larrow, Massachusetts resident. Eye and Ear Infirmary of Boston, in a news release.

"This is especially important because this type of discomfort could easily be attributed to more common diagnoses such as asthma," he said.

While there have been several reports of vocal cord paralysis in adults, this is the first report of the complication in an adolescent, the researchers said. The case report was published December 19 in the journal Pediatrics .

The otherwise healthy 15-year-old girl arrived at Massachusetts General Hospital’s emergency room with difficulty breathing, nine days after she was diagnosed with COVID. Doctors performed a laryngoscopy and discovered that both vocal cords in her larynx were paralyzed. They concluded that the paralysis was likely an aftereffect of her infection, since a thorough examination revealed no other cause.

COVID is known to affect the nervous system in other ways, the researchers noted. These include headache, dizziness, mental confusion, and altered taste and smell. Doctors first tried speech therapy to relieve the girl’s respiratory symptoms. When that didn’t work, they used surgery to create an opening in her windpipe that relieved her breathing problems, a procedure called a tracheostomy.

The girl relied on her tracheostomy for more than 13 months to help her breathe, an indication that this type of nerve symptom caused by COVID may not be temporary, doctors said.

Doctors removed the tracheostomy 15 months after it was inserted, just in time for the girl’s high school prom. "He was celebrating his prom a year and a quarter after the date he lost his function, and he told me he wasn’t going to go to prom with the tracheostomy in place," said lead author Dr. Christopher Hartnick. , director of the Division of Pediatric Otolaryngology and the Pediatric Airway, Voice and Swallowing Center at Mass Eye and Ear, in a news release. “We decided to intervene so she could graduate high school and go to her prom without a tracheotomy, which she did,” Hartnick said.

These types of complications are generally not expected in healthy young children and adolescents. Researchers noted that more than 15 million cases of pediatric COVID infection have been reported.

"The fact that children can have long-term neurotrophic effects from COVID-19 is something that is important for the pediatric community at large to be aware of so we can treat our children well," Hartnick said.

Source : Massachusetts Eye and Ear Infirmary , news release, December 19, 2023