Increased Incidence of Ulcerative Laryngitis During Spring 2022 Omicron-Variant Wave of COVID19

OBJECTIVES: Ulcerative laryngitis is a distinctive condition which typically follows illness with severe cough, and is characterized by dysphonia, ulcerative lesions of the vocal folds, and a prolonged clinical course. We present four patients with ulcerative laryngitis who presented in close succession amid the surge in omicron-variant COVID19 cases. STUDY DESIGN: Retrospective review. METHODS: Patient records for patients with ulcerative laryngitis from April and May 2022 were reviewed and compared with patients who presented with the same diagnosis from January 2017 through March 2022. Incidence, patient demographics, occupation, vaccination status, disease history, and treatment were obtained and compared. RESULTS: Four patients presented with ulcerative laryngitis over six weeks. Compared to the previous 4 years, this represented an eight-fold increase in monthly incidence. Average time from symptom onset to presentation was 15 days. All patients presented with dysphonia, with an average VHI10 of 23 and SVHI10 of 28. Two patients were COVID positive, one negative, and one had unknown COVID status. Three patients were fully vaccinated while one patient had only received one dose. Treatments included voice rest, steroids, antibiotics, antireflux medicine, and cough suppressants. Clinical course tended to be shorter and outcomes similar to the comparison group. CONCLUSION: The incidence of ulcerative laryngitis appeared to increase markedly with the prevalence of omicron-variant COVID19. Potential explanations include the apparent upper airway focus of omicron infection in contrast with prior variants and/or change in COVID19 infection characteristics in a vaccinated population.