DAYS after falling ill with Covid-19, an otherwise healthy teenage girl turned up at A&E struggling to breathe.
The cause of her breathing distress gave doctors pause, after tests revealed the virus had paralysed her vocal cords.
Shortness of breath, fatigue, memory problems and heart palpitations have all been named as lingering side effects brought on by a Covid infection.
But this was the first time complications affecting the vocal cords have been documented in a child or adolescent, physician-researchers from the Massachusetts Eye and Ear teaching hospital said.
The 15-year-old went to the emergency department at Massachusetts General Hospital with respiratory distress and noisy breathing two weeks after testing positive for Covid-19.
The study – published in the journal Pediatrics – notes that she had a history of asthma and anxiety. The teen told doctors that she'd started feeling short of breath nine days after falling ill.
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After examining her with an endoscope – a tube with a small camera inside that's used to look inside the body – doctors discovered that both of the vocal cords in her voice box were paralysed.
They concluded that the paralysis was nervous system-related complication of the virus.
Author Danielle Reny Larrow, a resident in the Department of Otolaryngology-Head and Neck Surgery at Massachusetts Eye and Ear, said: “Given how common this virus is among children, this newly recognised potential complication should be considered in any child presenting with a breathing, talking or swallowing complaint after a recent Covid-19 diagnosis.
“This is especially important as such complaints could be easily attributed to more common diagnoses such as asthma.”
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While paralysis of one vocal cord can cause issues with breathing, swallowing and speaking, researchers wrote that paralysis of both of them "poses a unique challenge" as it can result in respiratory distress might require the insertion of a surgical airway in severe cases.
Doctors diagnosed the 15-year-old with paradoxical vocal fold movement.
When you take a breath, your vocal folds should open to let air through to your lungs, but the teen's were closing instead, making it hard for her to breath.
As a result, she was referred to speech therapy, but this failed to relieve her symptoms. She underwent a tracheostomy, where an opening is surgically in the windpipe.
The procedure helped alleviate's the girl's breathing difficulties but she remained dependent on the tracheostomy for 15 months.
This suggested that the type of nerve complication she experienced may not be temporary, researchers said.
Doctors were able to remove the device just in time for teen's senior prom.
Senior author and director of the Division of Pediatric Otolaryngology and Pediatric Airway, Voice, and Swallowing Center at Massachusetts Eye and Ear, Christopher Hartnick, said: “She was having her senior prom a year and a quarter to the date of when she lost her function, and she told me she was not going to go to the prom with her tracheostomy in place.
“We decided to intervene so that she could graduate high school and go to her prom tracheostomy-free, which she did.”
Researchers said there have been several reports of paralysis in one or both vocal cords in adults following a Covid infection.
But this is the first report of the complication in an adolescent, they noted.
This is important, the authors said, because these types of complications are not usually expected in young, healthy individuals.
Dr Hartnick said: “To have a young, healthy, vibrant high schooler all of a sudden lose one of their important cranial nerves such that they can't breathe is highly unusual and took some parsing.
“The fact that kids can actually have long term neurotrophic effects from Covid-19 is something that it's important for the broader paediatric community to be aware of in order to be able to treat our kids well.”
What are the symptoms of paradoxical vocal fold movement?
Paradoxical vocal fold movement happens when your vocal folds close when in fact they should open.
The condition can be confused with asthma, but it's in fact a problem with how the vocal folds move.
It causes symptoms like:
- Coughing
- Rough-sounding voice
- difficulty breathing air in
- Noisy breathing
- Tightness in the throat
- Lightheadedness
- Sudden loss of voice
Source: American Speech-Language-Hearing Association
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