Teen’s Vocal Cord Paralysis Deemed Complication of COVID-19

Vocal cord pathology should be considered in children and teens who experience voice, swallowing, or breathing difficulties after SARS-CoV-2 infection, suggests a case report published online ahead of print in the journal Pediatrics.

The report is the first to describe a pediatric patient with bilateral vocal cord paralysis after COVID-19. The 15-year-old girl was presented to the emergency department at Massachusetts General Hospital with respiratory distress 9 days after testing positive with a mild SARS-CoV-2 infection. Endoscopic evaluation revealed bilateral vocal cord paralysis.

“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, MD, director of the Division of Pediatric Otolaryngology and Pediatric Airway, Voice, and Swallowing Center at Mass Eye and Ear.

The case report describes a detailed battery of diagnostic tests administered to the patient, which included blood work, imaging, and cerebrospinal fluid analysis, as well as consultations with otolaryngology, neurology, psychiatry, speech language pathology, and neurosurgery professionals. The team concluded the paralysis was likely a downstream effect of COVID-19.

After speech therapy failed to improve her symptoms, the patient received a tracheostomy. She remained tracheostomy-dependent for more than 13 months.

Although there have been reports of vocal cord paralysis after SARS-CoV-2 infection in adults, the complication is not likely to be expected in young, healthy patients.

“Given how common this virus is among children, this newly recognized potential complication should be considered in any child presenting with a breathing, talking, or swallowing complaint after a recent COVID-19 diagnosis,” said corresponding author Danielle Reny Larrow, MD, a resident in the Mass Eye and Ear Department of Otolaryngology-Head and Neck Surgery. “This is especially important as such complaints could be easily attributed to more common diagnoses such as asthma.”

In a press release accompanying the online publication of the case report, the clinical team provided an update: physicians removed the tracheostomy 15 months after its insertion.

“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,” Dr Hartnick said. “We decided to intervene so that she could graduate high school and go to her prom tracheostomy-free, which she did.”

References

Larrow DR, Hartnick C. Bilateral vocal cord paralysis requiring long-term tracheostomy after SARS-CoV-2 infection. Pediatrics. Published online December 19, 2023. doi:10.1542/peds.2023-061897

COVID-19 infection causes teen’s vocal cord paralysis in first-of-its-kind case. News release. Massachusetts Eye and Ear Infirmary; December 19, 2023. Accessed December 26, 2023.