We’re still discovering new ways COVID-19 can harm us, some four years after the emergence of this complicated viral disease. In a recent report, doctors in Massachusetts describe a teen girl whose vocal cords became paralysed soon after a bout of COVID-19. The girl required a tracheostomy in place for more than a year to help her breathe, though doctors did eventually remove it.
The case report, published this week in the journal Pediatrics, was written by doctors from Mass Ear and Ear, a part of Mass General Brigham, the state’s largest health care system. According to the report, the 15-year-old girl first visited the emergency room with symptoms of laboured, rapid, and noisy breathing. A physical examination revealed that she had developed paralysis of both her vocal cords. The otherwise healthy girl underwent a lengthy series of tests that tried and failed to find a clear explanation for her condition. However, nine days before her ER visit, she had tested positive for SARS-CoV-2, the virus that causes COVID-19. And though her initial illness was mild and had already cleared up, the doctors believe that the infection was likely the culprit behind her vocal cord paralysis.
One known trigger of vocal cord paralysis is neuropathy, or nerve damage. Research has suggested that COVID-19 can potentially cause neuropathy, and there have been other reports of vocal cord paralysis linked to SARS-CoV-2 infection. But as far as these doctors know, this is the first such incident of paralysis in both vocal cords ever documented in a teenager. This case is even stranger since many similar reports have been tied to prolonged intubation in hospitalised patients, whereas this girl only had mild illness. But the authors did find isolated reports of paralysis linked to mild COVID-19 as well.
Scientists are still trying to understand how COVID-19 can cause neuropathy and other lingering complications. It’s possible that nerve damage could arise from the coronavirus directly infecting certain nerve cells, for example. But the infection might also indirectly trigger neuropathy by causing nearby inflammation or blood vessel damage. In some cases, it may be a mix of all the above.
“The virus has known neurologic complications, including headache, seizure, and peripheral neuropathy,” the doctors wrote. “The current case reveals that vocal cord paralysis may be an additional neuropathic sequela of the virus.”
Bilateral vocal cord paralysis can be life-threatening, since it can stop air from reaching a person’s lungs and suffocate them. Doctors initially tried and failed to treat the girl’s paralysis with speech therapy. So they then opted to give her a tracheostomy, or a surgical opening in the windpipe. As of the case report’s submission, the girl had been dependent on tracheostomy for more than 13 months. But the doctors were able to intervene just in time for her to attend her high school prom and graduation ceremony without it.
These cases appear to be rare, and COVID-19 in general has gotten less dangerous over time. But the report authors say that doctors should remain vigilant and suspect COVID-19 when they come across patients with similar symptoms.
“The possibility of vocal cord pathology should be included in the differential diagnosis of children who present with voice, swallowing, or breathing complaints after SARS-CoV-2 infection,” they wrote.