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Bilateral Recurrent Laryngeal Nerve Paralysis Manifesting as Long COVID

Management with ventilation is used for severe cases of coronavirus disease 2019 (COVID-19). After extubation, recurrent laryngeal nerve paralysis due to various factors may occur. Almost all cases of paralysis develop unilaterally; however, bilateral recurrent laryngeal nerve paralysis occurs rarel...

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Autores principales: Okuda, Hiroshi, Kunieda, Chikako, Shibata, Hirofumi, Ohashi, Toshimitsu, Ogawa, Takenori
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449337/
https://www.ncbi.nlm.nih.gov/pubmed/36106228
http://dx.doi.org/10.7759/cureus.27792
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author Okuda, Hiroshi
Kunieda, Chikako
Shibata, Hirofumi
Ohashi, Toshimitsu
Ogawa, Takenori
author_facet Okuda, Hiroshi
Kunieda, Chikako
Shibata, Hirofumi
Ohashi, Toshimitsu
Ogawa, Takenori
author_sort Okuda, Hiroshi
collection PubMed
description Management with ventilation is used for severe cases of coronavirus disease 2019 (COVID-19). After extubation, recurrent laryngeal nerve paralysis due to various factors may occur. Almost all cases of paralysis develop unilaterally; however, bilateral recurrent laryngeal nerve paralysis occurs rarely. Such cases may be fatal due to upper air obstruction, and patients are forced to adhere to restrictions after a tracheotomy. The present case illustrates bilateral recurrent laryngeal nerve paralysis that occurred 48 hours after withdrawal from the ventilator. A 75-year-old woman with a history of hypertension came to our hospital with a history of fever and cough for five days. She was diagnosed with pneumonia due to COVID-19 via polymerase chain reaction using her saliva, and ground-glass opacity was found in both lung fields on chest X-ray and computed tomography (CT). Mechanical ventilation, steroids, remdesivir, and baricitinib were administered. The patient's fever and oxygenation status improved with these treatments, and she was weaned from the ventilator on the eighth day of hospitalization. She had no symptoms immediately. However, 48 hours after extubation, bilateral recurrent laryngeal nerve paralysis was suspected. Thus, oral intubation was immediately introduced and a tracheostomy was performed. Vocal cord movement disorders continued for eight weeks, and during that period, the patient displayed hoarseness and suffered from dysphagia. We considered that nerve disorders from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in addition to the compression by the endotracheal tube, caused bilateral recurrent laryngeal nerve paralysis. The neural injury by SARS-CoV-2 may prolong and manifest as "Long COVID."
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spelling pubmed-94493372022-09-13 Bilateral Recurrent Laryngeal Nerve Paralysis Manifesting as Long COVID Okuda, Hiroshi Kunieda, Chikako Shibata, Hirofumi Ohashi, Toshimitsu Ogawa, Takenori Cureus Emergency Medicine Management with ventilation is used for severe cases of coronavirus disease 2019 (COVID-19). After extubation, recurrent laryngeal nerve paralysis due to various factors may occur. Almost all cases of paralysis develop unilaterally; however, bilateral recurrent laryngeal nerve paralysis occurs rarely. Such cases may be fatal due to upper air obstruction, and patients are forced to adhere to restrictions after a tracheotomy. The present case illustrates bilateral recurrent laryngeal nerve paralysis that occurred 48 hours after withdrawal from the ventilator. A 75-year-old woman with a history of hypertension came to our hospital with a history of fever and cough for five days. She was diagnosed with pneumonia due to COVID-19 via polymerase chain reaction using her saliva, and ground-glass opacity was found in both lung fields on chest X-ray and computed tomography (CT). Mechanical ventilation, steroids, remdesivir, and baricitinib were administered. The patient's fever and oxygenation status improved with these treatments, and she was weaned from the ventilator on the eighth day of hospitalization. She had no symptoms immediately. However, 48 hours after extubation, bilateral recurrent laryngeal nerve paralysis was suspected. Thus, oral intubation was immediately introduced and a tracheostomy was performed. Vocal cord movement disorders continued for eight weeks, and during that period, the patient displayed hoarseness and suffered from dysphagia. We considered that nerve disorders from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in addition to the compression by the endotracheal tube, caused bilateral recurrent laryngeal nerve paralysis. The neural injury by SARS-CoV-2 may prolong and manifest as "Long COVID." Cureus 2022-08-08 /pmc/articles/PMC9449337/ /pubmed/36106228 http://dx.doi.org/10.7759/cureus.27792 Text en Copyright © 2022, Okuda et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Emergency Medicine
Okuda, Hiroshi
Kunieda, Chikako
Shibata, Hirofumi
Ohashi, Toshimitsu
Ogawa, Takenori
Bilateral Recurrent Laryngeal Nerve Paralysis Manifesting as Long COVID
title Bilateral Recurrent Laryngeal Nerve Paralysis Manifesting as Long COVID
title_full Bilateral Recurrent Laryngeal Nerve Paralysis Manifesting as Long COVID
title_fullStr Bilateral Recurrent Laryngeal Nerve Paralysis Manifesting as Long COVID
title_full_unstemmed Bilateral Recurrent Laryngeal Nerve Paralysis Manifesting as Long COVID
title_short Bilateral Recurrent Laryngeal Nerve Paralysis Manifesting as Long COVID
title_sort bilateral recurrent laryngeal nerve paralysis manifesting as long covid
topic Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449337/
https://www.ncbi.nlm.nih.gov/pubmed/36106228
http://dx.doi.org/10.7759/cureus.27792
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