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.