Postacute COVID‐19 Laryngeal Injury and Dysfunction

Abstract

Objective Patients with COVID-19 are at risk for laryngeal injury and dysfunction secondary to respiratory failure, prolonged intubation, and other unique facets of this illness. Our goal is to report clinical features and treatment for patients presenting with voice, airway, and/or swallowing concerns postacute COVID-19. Study Design Case series. Setting Academic tertiary care center. Methods Patients presenting with laryngeal issues following recovery from COVID-19 were included after evaluation by our laryngology team. Data were collected via retrospective chart review from March 1, 2020, to April 1, 2021. This included details of the patient’s COVID-19 course, initial presentation to laryngology, and subsequent treatment. Results Twenty-four patients met inclusion criteria. Twenty (83%) patients were hospitalized, and 18 required endotracheal intubation for a median (range) duration of 14 days (6-31). Ten patients underwent tracheostomy. Patients were evaluated at a median 107 days (32-215) after their positive SARS-CoV-2 test result. The most common presenting concerns were dysphonia (n = 19, 79%), dyspnea (n = 17, 71%), and dysphagia (n = 6, 25%). Vocal fold motion impairment (50%), early glottic injury (39%), subglottic/tracheal stenosis (22%), and posterior glottic stenosis (17%) were identified in patients who required endotracheal intubation. Patients who did not need intubation were most frequently treated for muscle tension dysphonia (67%). Conclusion Patients may develop significant voice, airway, and/or swallowing issues postacute COVID-19. These complications are not limited to patients requiring intubation or tracheostomy. Multidisciplinary laryngology clinics will continue to play an integral role in diagnosing and treating patients with COVID-19–related laryngeal sequelae.

An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic

“…Globus-type presentations and muscle tension dysphonia and dysphagia have been reported at centers in London, UK, with one reported case of a laryngeal “tic” post-COVID-19 infection (Ratcliffe, personal correspondence). This corroborates with the 6 patients reported by Neeval et al who had not been intubated, 4 of these with muscle tension dysphonia [ 90 ]. Outpatient ENT and voice clinics are seeing new onset idiopathic vocal fold palsies consistent with vagus nerve viral infections (Table 3 ).…”

“…Twenty of the patients had been hospitalized, with 18 requiring intubation. Varying laryngeal injuries, dysphonia (79%), and dysphagia (25%) were common [ 90 ]. Our original data add to this sequelae (Wallace, unpublished data; Robinson, unpublished data) with the most prevalent reported symptom dysphonia (range: 29%–79%) with a high incidence of vocal fold palsy, granuloma, arytenoid prolapse, edema, and muscle tension (Table 3 ; Figs.…”

“…Breathing difficulties, ongoing chronic cough, globus, and pain continue as common symptoms after COVID-19 [ 90 , 91 ] (Table 3 ) and are of interest to SP, particularly when considering appropriate therapeutic management. SPs who specialize in upper airway disorders may notice these symptoms with referrals as 2021 progresses.…”

COVID-19 and laryngological surgery

“…Neevel et al also reported a case series of patients presenting with laryngeal issues post-COVID-19 recovery. 46 Twenty-four patients over a 13-month range were evaluated, of which only 18 patients required endotracheal intubation for a median duration of 14 days and 10 patients underwent tracheotomy. When evaluated at a median of 107 days after initially testing positive for SARS-CoV-2, the common presenting concerns were dysphonia, dyspnea, and dysphagia, from greatest frequency to least.…”

“…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 …”