A case of Covid-19 associated laryngeal synechia as a cause for failed tracheostomy decannulation

Post intubation laryngeal injuries are seen relatively commonly in the Intensive Care Unit (ICU) setting. The most common intubation associated laryngeal injuries are characterised by vocal cord oedema, mucosal ulceration, laryngeal granulomas and vocal cord paralysis. Laryngeal stenosis is seen much less commonly and generally presents with posterior adhesions from prolonged intubation or anterior webbing from instrumentation. The finding of adhesions between the vocal cords at the middle third of the glottis without anterior or posterior adhesions and in the absence of previous laryngeal surgery is rare. The authors present a case of a patient with Covid-19 (SARS-CoV-2) who was discovered to have this finding following admission to the Intensive Care Unit for ventilation, tracheostomy for weaning and subsequent failure to decannulate. The patient underwent a microlaryngoscopy and frank adhesions between the middle third of the vocal cords were noted. The authors feel that the mucosal inflammatory component associated with Covid-19 was a significant contributing factor in this clinical finding. Following successful divisions of the adhesions, the patient made a full recovery.