Teenage Girl Left With Paralyzed Vocal Cords From COVID in First-Ever Case

A healthy 15-year-old girl had her vocal cords paralyzed after contracting COVID-19.

The patient was admitted with "severe respiratory distress" to Mass Eye and Ear, a member of Mass General Brigham, nine days after contracting the virus. An examination with an endoscope revealed that both her vocal cords and voice box had become paralyzed, which her doctors concluded were likely the downstream effects of the COVID-19 infection.

Neurological complications brought on by COVID-19 most likely caused the symptom, researchers said in a case study published on December 19 in the journal Pediatrics.

"Given how common this virus is among children, this newly recognized potential complication should be considered in any child presenting with a breathing, talking or swallowing complaint after a recent COVID-19 diagnosis," first author Danielle Reny Larrow, a resident researcher in the Department of Otolaryngology-Head and Neck Surgery at Mass Eye and Ear, said in a statement. "This is especially important as such complaints could be easily attributed to more common diagnoses such as asthma."

After speech therapy failed to relieve the patient's symptoms, she was given a tracheostomy—a surgical procedure that involved creating an opening in the windpipe. She remained dependent on the tracheostomy for 15 months, although her doctors noted it was removed just in time for her high school graduation and senior prom.

"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," senior author Christopher Hartnick, M.D., director of the Division of Pediatric Otolaryngology and Pediatric Airway, Voice, and Swallowing Center at Mass Eye and Ear, said in a statement.

"We decided to intervene so that she could graduate high school and go to her prom tracheostomy-free, which she did," he said.

Neurological conditions like this are known to occur after viral infections and have previously been shown to cause vocal cord paralysis in adults. This is the first time the complication has been reported in an adolescent.

"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," Hartnick said. "The fact that kids can actually have long term neurotrophic effects from COVID-19 is something that it's important for the broader pediatric community to be aware of in order to be able to treat our kids well."

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