key: cord-0021143-05ut2xun
authors: Al-Ani, Raid M.; Rashid, Rasheed Ali
title: Commentary on the Letter to the Editor regarding "Dysphonia in COVID-19 patients: Direct or indirect symptom?
date: 2021-09-21
journal: Am J Otolaryngol
DOI: 10.1016/j.amjoto.2021.103245
sha: bb52e4fe02916c27113689dc81d31ae6ef2edc81
doc_id: 21143
cord_uid: 05ut2xun

nan

Thank you very much for inviting us to comment on the "letter to the editor" by Lechien et al. entitled "Dysphonia in COVID-19 Patients: Direct or indirect Symptom ?". Certainly, this indicates your keenness to advance in the field of scientific research. Our comments on the abovementioned manuscript are presented below.

The SARS-CoV-2 invade the target cells that contain angiotensinconverting enzyme 2 (ACE2), although this enzyme is distributed mainly in the respiratory and gastrointestinal tracts, it can enter any cell in the body [1] [2] . Therefore, there is a diversity and wide range of COVID-19 symptoms. We concentrated in our published article "Prevalence of dysphonia due to COVID-19 at Salahaddin General Hospital, Tikrit City, Iraq" in the Materials and Methods section on the most common symptoms and followed them by the abbreviation, etc.. as it appears in the following sentence [presenting symptoms (fever, cough, dyspnea, anosmia, ageusia, headache, myalgia, dysphonia, etc..)] [3] . Furthermore, when we reviewed the case sheets of the patients, we registered every patient symptom. Therefore, symptoms of laryngopharyngeal reflux disease, postnasal drip, and rhinorrhea were taken into consideration. No patient has complained of the previously mentioned symptoms.

All the patients in our study were subjected to systemic steroids, without a corticosteroid inhaler as revealed from the findings in the case sheets of the patients, according to the Iraqi Ministry of Health protocol for the treatment of the inpatients with COVID-19. Also, this is mentioned in the Materials and Methods section [The treatment were included systemic steroids and supportive treatment according to the recommended regime by the Ministry of Health, Iraq.] [3] .

The title of the letter to the editor "Dysphonia in COVID-19 Patients:

Direct or indirect Symptom ?" is attractive. However, we would like to share our suggestion for a slight change in the title to be as follows "Dysphonia in COVID-19 Patients: Indirect or direct Symptom ?". Our suggestion is based on that the dysphonia post-COVID-19 is due to mainly indirect causes and the persistent nature of the symptom [4] . Lastly, we congratulate the famous authors for their excellent job which contains rich information based on high-quality references.

Neuroinfection may contribute to pathophysiology and clinical manifestations of COVID-19

Vocal disorders in patients with COVID 19 in Egypt

Prevalence of dysphonia due to COVID-19 at Salahaddin General Hospital, Tikrit City, Iraq

Persistent dysphonia in hospitalized COVID-19 patients