Acute Vocal Fold Paresis and Paralysis After COVID-19 Infection: A Case Series

Abstract

Objective: Evidence demonstrates neurotropism is a common feature of coronaviruses. In our laryngology clinics we have noted an increase in cases of “idiopathic” vocal fold paralysis and paresis in patients with no history of intubation who are recovering from the novel SARS-Cov-2 coronavirus (COVID-19). This finding is concerning for a post-viral vagal neuropathy (PVVN) as a result of infection with COVID-19. Our objective is to raise the possibility that vocal fold paresis may be an additional neuropathic sequela of infection with COVID-19. Methods: Retrospective review of patients who tested positive for COVID-19, had no history of intubation as a result of their infection, and subsequently presented with vocal fold paresis between May 2020 and January 2021. Charts were reviewed for demographic information, confirmation of COVID-19 infection, presenting symptoms, laryngoscopy and stroboscopy exam findings, and laryngeal electromyography (LEMG) results. Results: Sixteen patients presented with new-onset dysphonia during and after recovering from a COVID-19 infection and were found to have unilateral or bilateral vocal fold paresis or paralysis. LEMG was performed in 25% of patients and confirmed the diagnosis of neuropathy in these cases. Conclusions: We believe that COVID-19 can cause a PVVN resulting in abnormal vocal fold mobility. This diagnosis should be included in the constellation of morbidities that can result from COVID-19 as the otolaryngologist can identify this entity through careful history and examination.

An 18-Year-Old Female Experiences Unilateral Vocal Cord Paralysis during Mild COVID-19 Infection

“…At times, the virus has been shown to produce neurological symptoms like anosmia, Guillain–Barre, Bell's palsy, and encephalopathy [ 12 – 16 ]. In addition, rare cases have been reported of COVID-19-related VCP [ 7 , 17 – 20 ]. These patients typically develop vocal cord dysfunction at the onset of a COVID-19 infection concurrent with the development of traditional viral symptoms.…”

The First Case Report of Bilateral Vagal Neuropathy Presenting With Dysphonia Following COVID-19 Infection

“… 3 Recently, Sarah K. Rapoport et al reported a case series of vocal fold paresis and paralysis after COVID-19 infection, which was thus suggested to have caused by post viral vagal neuropathy. 4 The distinct mechanism is not yet known.…”

COVID-19 and laryngological surgery

“…Rapaport and colleagues (including the senior author, RTS) reported a case series of 16 patients with new-onset dysphonia following COVID-19 infection. 45 All patients were found to have idiopathic VF paresis or paralysis despite having no prior history of intubation. Neuropathy was confirmed by LEMG in some of those patients.…”

“…There is an anticipated increase in need for laryngeal surgery such as vocal fold medialization for paresis, repair of intubation injuries (including vocal fold scar, arytenoid joint fixation, laryngeal stenosis repair, and others) for some patients with prolonged intubation. 45 , 46 , 47 …”