COVID-19 Triggers First Ever Vocal Cord Paralysis in Teens

A 15-year-old girl contracted COVID-19 and went on to develop bilateral vocal cord paralysis, in a first-of-its-kind occurrence. Vocal cord paralysis can be a nervous system-related (neuropathic) consequence of the SARS-CoV virus, according to a case report published in the journal Pediatrics (1^✔ ✔Trusted Source
Bilateral Vocal Cord Paralysis Requiring Long-term Tracheostomy After SARS-CoV-2 Infection

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COVID-19 & Its Post-Viral Neuropathy in Teenagers

The patient, an otherwise healthy girl, was presented at the emergency department at Massachusetts General Hospital with symptoms of respiratory distress nine days after diagnosis with SARS-CoV-2 infection. Examination with an endoscope revealed bilateral vocal cord paralysis, which is an immobility of both vocal cords found in the larynx or voice box. According to physician-researchers at Mass Eye and Ear, a member of Mass General Brigham, it is “The first pediatric case of bilateral vocal cord paralysis after COVID and was likely a downstream effect of the COVID.”

“Given how common this virus is among children, this newly-recognized potential complication should be considered in any child presenting with breathing, talking, or swallowing complaint after a recent COVID-19 diagnosis,” said first author Danielle Reny Larrow, a resident in the Department of Otolaryngology-Head and Neck Surgery at Mass Eye and Ear.

“This is especially important as such complaints could be easily attributed to more common diagnoses such as asthma.” While at the hospital, the patient underwent a detailed battery of diagnostic tests including blood work, imaging, cerebrospinal fluid analysis, and consultations with otolaryngology, neurology, psychiatry, speech-language pathology, and neurosurgery.

When speech therapy failed to relieve the patient’s symptoms, the physicians performed a tracheostomy -- a surgically created opening in the windpipe -- to relieve the patient’s breathing difficulties. She remained tracheostomy-dependent for more than 13 months after initial treatment, suggesting that this type of nerve complication may not be temporary.

Following the submission of this case report, the physicians were able to remove the tracheostomy -- 15 months after it was inserted and just in time for the patient’s high school graduation and prom. “She was having her senior prom a year and a quarter to the date of when she lost her function, and she told me she was not going to go to the prom with her tracheostomy in place,” Hartnick said.

“We decided to intervene so that she could graduate high school and go to her prom tracheostomy-free, which she did.” Post-viral neuropathy is a known cause of vocal cord paralysis, and there have been several reports of paralysis in one or both vocal cords of adults as a complication of SARS-CoV-2 infection, but this is the first report of the complication in an adolescent.

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This is important, the team said, because these types of complications are not usually expected in young, healthy individuals and there have been more than 15 million reported cases of pediatric SARS-CoV-2 infection. “To have a young, healthy, vibrant high schooler all of a sudden lose one of their important cranial nerves such that they can't breathe is highly unusual and took some parsing,” said senior author Christopher Hartnick, director of the Division of Pediatric Otolaryngology at Mass Eye and Ear.

Reference:

1. Bilateral Vocal Cord Paralysis Requiring Long-term Tracheostomy After SARS-CoV-2 Infection - (https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2023-061897/196221/Bilateral-Vocal-Cord-Paralysis-Requiring-Long-term)

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