Laryngeal manifestations of COVID 19
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Abstract
Introduction: COVID 19 infection affects the upper aerodigestive tract through angiotensin-converting enzyme 2 (ACE2) and/or Transmembrane serine protease 2 (TMPRSS2). Its acute manifestations and sequelae have been very varied, and not all of them are related to orotracheal intubation. The objective is to describe the sociodemographic and clinical characteristics and the endoscopic findings of pa[1]tients with laryngopharyngeal symptoms after SARS-CoV-2 infection evaluated at the Hospital Militar Central and Hospital Universitario Clínica San Rafael between March 2020 and March 2022. Methods: Cross-sectional observational study, obtai[1]ning sociodemographic data, comorbidities, need for orotracheal intubation, variety of symptoms and their endoscopic findings. Results: 118 patients were collected; the mean age was 51 years ± 14.4. The most frequent symptom was dysphonia (69.5%), followed by dyspnea (39.8%). 58.9% required orotracheal intubation and of these the most frequent manifestation was muscular tension dysphonia (MTD) and subglottic[1]tracheal stenosis. In the remaining 41.1%, the most frequent finding was irritative laryngitis. Conclusions: COVID-19 has multiple laryngopharyngeal manifestations in relation to its mechanism of infection and invasion in the tissues of this area, as an inflammatory and structural type, and not all of them are related to intubation.
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ISSN: 0120-8411
References
World Healh Organization (WHO). WHO Coronavirus (COVID-19) Dashboard [Internet]. 2022[citado en mayo de 2022]. Disponible en: https://covid19.who.int/
El-Anwar MW, Elzayat S, Fouad YA. ENT manifestation in COVID-19 patients. Auris Nasus Larynx. 2020;47(4):559-64. doi: 10.1016/j.anl.2020.06.003
Wu J, Weng W. COVID-19 virus released from larynx might cause a higher exposure dose in indoor environment. Environ Res. 2021;199:111361. doi: 10.1016/j.envres.2021.111361
Descamps G, Verset L, Trelcat A, Hopkins C, Lechien JR, Journe F, et al. ACE2 Protein Landscape in the Head and Neck Region: The Conundrum of SARS-CoV-2 Infection. Biology (Basel). 2020;9(8):235. doi: 10.3390/biology9080235
Sato T, Ueha R, Goto T, Yamauchi A, Kondo K, Yamasoba T. Expression of ACE2 and TMPRSS2 Proteins in the Upper and Lower Aerodigestive Tracts of Rats: Implications on COVID 19 Infections. Laryngoscope. 2021;131(3):E932-E939. doi: 10.1002/lary.29132
Das A, Roy S, Swarnakar S, Chatterjee N. Understanding the immunological aspects of SARS-CoV-2 causing COVID-19 pandemic: A therapeutic approach. Clin Immunol. 2021;231:108804. doi: 10.1016/j.clim.2021.108804
Naunheim MR, Zhou AS, Puka E, Franco RA Jr, Carroll TL, Teng SE, et al. Laryngeal complications of COVID-19. Laryngoscope Investig Otolaryngol. 2020;5(6):1117-124. doi: 10.1002/lio2.484
Neevel AJ, Smith JD, Morrison RJ, Hogikyan ND, Kupfer RA, Stein AP. Postacute COVID-19 Laryngeal Injury and Dysfunction. OTO Open. 2021;5(3):2473974X211041040. doi: 10.1177/2473974X211041040
Mattioli F, Marchioni A, Andreani A, Cappiello G, Fermi M, Presutti L. Post-intubation tracheal stenosis in COVID-19 patients. Eur Arch Otorhinolaryngol. 2021;278(3):847-48. doi: 10.1007/s00405-020-06394-w
Schweiger C, Manica D. Acute laryngeal lesions following endotracheal intubation: Risk factors, classification and treatment. Semin Pediatr Surg. 2021;30(3):151052. doi: 10.1016/j.sempedsurg.2021.151052
Brodsky MB, Levy MJ, Jedlanek E, Pandian V, Blackford B, Price C, et al. Laryngeal Injury and Upper Airway Symptoms After Oral Endotracheal Intubation With Mechanical Ventilation During Critical Care: A Systematic Review. Crit Care Med. 2018;46(12):2010-2017. doi: 10.1097/ CCM.0000000000003368
Ramos PH, Lagos AE, Napolitano CA, Badía PI. Postintubation Phonatory Insufficiency: A Challenging Diagnosis. J Voice. 2022;36(4):554-58. doi: 10.1016/j.jvoice.2020.07.011
Decavel P, Nahmias O, Petit C, Tatu L. Lower Cranial Nerve Palsies in the COVID-19 Pandemic: A 10-Case Series of Intensive Care Unit Patients. Eur Neurol. 2022;85(2):136-39. doi: 10.1159/000519226
Ftiha F, Shalom M, Jradeh H. Neurological symptoms due to Coronavirus disease 2019. Neurol Int. 2020;12(1):8639. doi: 10.4081/ni.2020.8639
Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020;92(6):552-55. doi: 10.1002/jmv.25728
Cavalagli A, Peiti G, Conti C, Penati R, Vavassori F, Taveggia G. Cranial nerves impairment in post-acute oropharyngeal dysphagia after COVID-19. Eur J Phys Rehabil Med. 2020;56(6):853-57. doi: 10.23736/S1973-9087.20.06452-7
Rees CJ, Henderson AH, Belafsky PC. Postviral vagal neuropathy. Ann Otol Rhinol Laryngol. 2009;118(4):247-52. doi: 10.1177/000348940911800402
Osbeck Sandblom H, Dotevall H, Svennerholm K, Tuomi L, Finizia C. Characterization of dysphagia and laryngeal findings in COVID-19 patients treated in the ICU-An observational clinical study. PLoS One. 2021;16(6):e0252347. doi: 10.1371/ journal.pone.0252347
Azzam AAA, Samy A, Sefein I, ElRouby I. Vocal Disorders in Patients with COVID 19 in Egypt. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 2):3420-426. doi: 10.1007/s12070- 021-02663-0
Rameau A, Young VN, Amin MR, Sulica L. Flexible Laryngoscopy and COVID-19. Otolaryngol Head Neck Surg. 2020;162(6):813-15. doi: 10.1177/0194599820921395
Marchioni D, Bisi N, Molteni G, Rubini A. Covid-19 and ENT practice: Our experience: ENT outpatient department, ward and operating room management during the SARS CoV-2 pandemic. Am J Otolaryngol. 2020;41(6):102676. doi: 10.1016/j.amjoto.2020.102676
Guven BB, Erturk T, Ersoy A. A serious complication after long-term covid-19 ards treatment: tracheal stenosis. (a case report). Acta Medica Mediterranea. 2021;37(6):2953-6. doi: 10.19193/0393-6384_2021_6_462
Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417- 418. doi: 10.1016/S0140-6736(20)30937-5
Raucci F, Mansour AA, Casillo GM, Saviano A, Caso F, Scarpa R, et al. Interleukin-17A (IL-17A), a key molecule of innate and adaptive immunity, and its potential involvement in COVID 19-related thrombotic and vascular mechanisms. Autoimmun Rev. 2020;19(7):102572. doi: 10.1016/j.autrev.2020.102572
Rosen C, Simpson C. Operative techniques in laryngology. Alemania: Springer; 2008.
Ferlito A. Diseases of the larynx. 3ª edición. San Diego: Plural Publishing; 2009.
Piazza C, Filauro M, Dikkers FG, Nouraei SAR, Sandu K, Sittel C, et al. Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society. Eur Arch Otorhinolaryngol. 2021;278(1):1-7. doi: 10.1007/s00405-020-06112-6
Scholfield DW, Warner E, Ahmed J, Ghufoor K. Subglottic and tracheal stenosis associated with coronavirus disease 2019. J Laryngol Otol. 2021;135(7):656-58. doi: 10.1017/ S0022215121001134
Al Omari A, Al-Qarqaz W, Khresat M, Sataloff RT. Tracheobronchopathia osteochondroplastica in the setting of COVID-19. Ear Nose Throat J. 2022:1455613221083822. doi: 10.1177/01455613221083822
Ershadi R, Rafieian S, Sarbazzadeh J, Vahedi M. Tracheal stenosis following mild-to-moderate COVID-19 infection without history of tracheal intubation: a case report. Gen Thorac Cardiovasc Surg. 2022;70(3):303-07. doi: 10.1007/ s11748-021-01747-6
Shih M, Devore D, Hollas SE, Ongkasuwan J. Post-intubation Glottic Insufficiency. En: Multidisciplinary Management of Pediatric Voice and Swallowing Disorders. Cham: Springer International Publishing; 2020. p. 423-30.
Piersiala K, Kakabas L, Bruckova A, Starkhammar M, Cardell LO. Acute odynophagia: A new symptom of COVID-19 during the SARS-CoV-2 Omicron variant wave in Sweden. J Intern Med. 2022;292(1):154-61. doi: 10.1111/joim.13470
Sahril S, Narayanan MS, Mohamad I. Managing supraglottitis in the COVID-19 era. Vis J Emerg Med. 2021;24:101092. doi: 10.1016/j.visj.2021.101092
Iwamoto S, Sato MP, Hoshi Y, Otsuki N, Doi K. COVID-19 presenting as acute epiglottitis: A case report and literature review. Auris Nasus Larynx. 2023;50(1):165-68. doi: 10.1016/j. anl.2021.12.007
Olivares MM, Zwiener RD, Panqueva LML, Contreras Verduzco FA, Mansour E, Rodriguez JA, et al. COVID-19 triggers attacks in HAE patients without worsening disease outcome. J Allergy Clin Immunol Pract. 2022;10(3):855-58. doi: 10.1016/j.jaip.2021.12.008
McGrath BA, Wallace S, Goswamy J. Laryngeal oedema associated with COVID-19 complicating airway management. Anaesthesia. 2020;75(7):972. doi: 10.1111/anae.15092
Asaoka M, Chubachi S, Yamada Y, Fukunaga K. A rare case of COVID-19 infection with laryngeal involvement. BMJ Case Rep. 2021;14(6):e242426. doi: 10.1136/bcr-2021-242426
Nishiyama Y, Wasano K. Endoscopic findings of laryngitis caused by SARS-CoV-2/Omicron variant infection. Infection. 2023;51(1):283-84. doi: 10.1007/s15010-022-01808-9
Oliver CM, Campbell M, Dulan O, Hamilton N, Birchall M. Appearance and management of COVID-19 laryngo-tracheitis: two case reports. F1000Res. 2020;9:310. doi: 10.12688/ f1000research.23204.2
Dominguez LM, Simpson CB. Viral laryngitis: a mimic and a monster - range, presentation, management. Curr Opin Otolaryngol Head Neck Surg. 2015;23(6):454-8. doi: 10.1097/ MOO.0000000000000203
Morrison M, Rammage L, Emami AJ. The irritable larynx syndrome. J Voice. 1999;13(3):447-55. doi: 10.1016/s0892- 1997(99)80049-6
Morrison M, Rammage L. The Irritable Larynx Syndrome as a Central Sensitivity
Syndrome. Revue canadienne d’orthophonie et d’audiologie. 2010;34(4):282-8.
Andrianopoulos MV, Gallivan GJ, Gallivan KH. PVCM, PVCD, EPL, and irritable larynx syndrome: what are we talking about and how do we treat it? J Voice. 2000;14(4):607-18. doi: 10.1016/s0892-1997(00)80016-8
Lechien JR, Circiu MP, Crevier-Buchman L, Hans S. Post COVID-19 paradoxical vocal fold movement disorder. Eur Arch Otorhinolaryngol. 2021;278(3):845-46. doi: 10.1007/ s00405-020-06391-z
Curros Mata N, Alvarado de la Torre S, Carballo Fernández J, Martínez Morán A, Álvarez Refojo F, Rama-Maceiras P. Late bilateral vocal cord palsy following endotracheal intubation due to COVID-19 pneumonia. Rev Esp Anestesiol Reanim (Engl Ed). 202026;69(2):105–8. English, Spanish. doi: 10.1016/j. redar.2020.11.010
Remacle M, Sulica L, Blitzer A. Vocal fold paralysis. Eur Arch Otorhinolaryngol. 2006;263(10):968-9. doi: 10.1007/s00405- 006-0081-3
Leis-Cofiño C, Arriero-Sánchez P, González-Herranz R, Arenas Brítez Ó, Hernández-García E, Plaza G. Persistent Dysphonia in Hospitalized COVID-19 Patients. J Voice. 2021:S0892- 1997(21)00234-4. doi: 10.1016/j.jvoice.2021.07.001
Al-Ani RM, Rashid RA. Prevalence of dysphonia due to COVID-19 at Salahaddin General Hospital, Tikrit City, Iraq. Am J Otolaryngol. 2021;42(5):103157. doi: 10.1016/j. amjoto.2021.103157
Regan J, Walshe M, Lavan S, Horan E, Gillivan Murphy P, Healy A, et al. Post-extubation dysphagia and dysphonia amongst adults with COVID-19 in the Republic of Ireland: A prospective multi-site observational cohort study. Clin Otolaryngol. 2021;46(6):1290-299. doi: 10.1111/coa.13832
Brodsky MB, Gilbert RJ. The Long-Term Effects of COVID-19 on Dysphagia Evaluation and Treatment. Arch Phys Med Rehabil. 2020;101(9):1662-664. doi: 10.1016/j. apmr.2020.05.006