Conclusions
In summary, in this patient dysphagia lasted longer than expected after an intubation but the source seems neither the intubation nor the Sars-CoV-2 but an interaction of both. Investigating the possible aetiology of vocal fold paresis, the instrumental exams allowed us to exclude vascular events, neoplasms and degenerative diseases [8]. It has not been possible to exclude post-intubation, post-viral and idiopathic aetiology. Regarding viral aetiology, in literature there are studies that correlate respiratory viral infections to vocal fold paresis due to the virus neurotropism [9] and there is an increasing evidence that the nervous system is frequently involved in patients with Covid-19 [10]. It was therefore not possible to identify with certainty the origin of vocal fold paresis in our patient.
Concerning the prognosis, there are no specific studies on recovery but the data suggests a good recovery within a year. Furthermore, this patient benefited from corticosteroid treatment, which targeted the hyperinflammation caused by the virus [10], and from intensive rehabilitation therapy with a good result in approximately 50 days.
At present in literature there are not many studies about Covid-19 and severe and prolonged dysphagia with the need of gastrostomy positioning. Moreover, vocal fold paresis during Covid-19 was not described yet and for this reasons a comparison is difficult.
The present case report shows that dysphagia in Covid-19 is not always mild and may cause serious complications. Therefore, we advise not to rely on a single evaluation and screening tests alone, but to monitor meal performance, especially in patients at high risk of dysphagia (such as those with long intubation or tracheotomy). Considering that sometimes the diagnosis of dysphagia is not obvious and the gold standard instrumental evaluations are limited due to the high risk of aerosol-generating, awareness about dysphagia in this patient population should be increased.
Moreover it seems important to start an appropriate and intensive rehabilitation treatment early with high-specialized professionals.
We hope that the history of this patient will help other healthcare professionals during their clinical practice.