Teen’s Vocal Cords Paralyzed After COVID-19 Infection in First-of-Its-Kind Case

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12/25/2023

A 15-year-old girl experienced vocal cord paralysis after a bout of COVID-19, according to a new case report. It’s the first time this particular complication of the disease has been reported in an adolescent, and medics are calling for greater awareness of this possibility, albeit rare, in children infected with SARS-CoV-2.

Over the almost four years that COVID-19 has been on the scene, it’s become increasingly clear that this infection hits very differently from person to person. For some, especially in the absence of vaccines, it leads to life-threatening disease; for others, a mild initial infection gives way to debilitating long-term issues; and still others are unaware that they’ve even been infected at all. 

Far from being just a respiratory pathogen, we now know that SARS-CoV-2 can affect multiple other organs and systems within the body. This latest case report adds to the body of evidence around the possible neurological complications of COVID-19 in both children and adults, detailing a case of vocal cord paralysis in a 15-year-old who was treated at Massachusetts General Hospital.

The girl first went to the emergency department after experiencing shortness of breath, around two weeks after contracting COVID-19. The acute symptoms of her infection had resolved within five days, but the breathing difficulties began nine days after her positive COVID test.

Because she had a history of asthma, the patient was treated with steroids and medicines to open up her airways, but she was also admitted to hospital for extensive further tests. Examination of the larynx (voice box) revealed that the movement of both vocal cords was impaired.

The patient underwent a lot of testing – including bloodwork, scans, and a lumbar puncture – and the medical team consulted with specialists in several disciplines, including speech language pathology. When speech therapy and a Botox injection didn’t relieve her symptoms, it was decided that a tracheostomy would be necessary. 

It took 15 months, but the medics were finally able to remove the tracheostomy just in time for the patient’s high school graduation.

“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,” said senior author Dr Christopher Hartnick, director of the Division of Pediatric Otolaryngology and Pediatric Airway, Voice, and Swallowing Center at Mass Eye and Ear, in a statement

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

Cases of vocal cord paralysis after a viral infection are not unheard-of, including in adults after COVID-19 – but this is the first such case in a teenager.

“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,” Hartnick said. 

“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.”

To date, estimates suggest that there have been over 15 million cases of SARS-CoV-2 infection in kids. Although complications like this may be rare, it’s important that the medical community remains alive to the possibility, especially because these kinds of symptoms can be mistaken for other, more common complaints.

First author Dr Danielle Reny Larrow, a resident in the Department of Otolaryngology-Head and Neck Surgery at Mass Eye and Ear, summarized, “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.”

The study is published in the journal Pediatrics

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