'First case of vocal cord paralysis following Covid infection in teenager'

NEW DELHI: Researchers have described the first pediatric case of vocal cord paralysis following COVID-19 infection in a new study.

The physician-researchers at Massachusetts Eye and Ear hospital in the US have concluded that the paralysis was likely a downstream effect of the viral infection, and that it may be another addition to the "well-established" nervous system-related or neuropathic complications observed in children and adults.

The patient, an otherwise healthy 15-year-old female, was presented to the emergency department 13 days after diagnosis of SARS-CoV-2 infection with acute onset shortness of breath, the researchers described in their study published in the journal Pediatrics. She had a history of asthma and anxiety.

An endoscopic examination revealed bilateral vocal cord paralysis, which refers to an immobility of both vocal cords found in the voice box or the 'larynx', the researchers said.

"Given how common this virus is among children, this newly recognised potential complication should be considered in any child presenting with a 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 Massachusetts Eye and Ear.

"This is especially important as such complaints could be easily attributed to more common diagnoses such as asthma," said Larrow.

While at the hospital, the patient underwent a detailed battery of diagnostic tests, including blood work, imaging, cerebrospinal fluid analysis and consultations with otolaryngology (medicine specialty dealing with diseases of ear, nose and throat), neurology, psychiatry, speech language pathology and neurosurgery, the researchers said.

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.

They reported that she remained tracheostomy-dependent for more than 13 months after initial treatment, suggesting that this type of nerve complication may not be temporary.

They said were able to remove it fifteen months after insertion following a case report submission.

Describing it as "highly unusual", the team said that this was the first report of an adolescent experiencing post-viral neuropathy, which is known to cause vocal cord paralysis, even as several adults have reported this complication as a result of COVID-19 infection.

"The fact that kids can actually have long term neurotrophic effects from COVID-19 is something that it's important for the broader pediatric community to be aware of in order to be able to treat our kids well," said senior author Christopher Hartnick, director of the Division of Pediatric Otolaryngology and Pediatric Airway, Voice, and Swallowing Center at Massachusetts Eye and Ear.