key: cord-0722054-hfeva0pz
authors: Lechien, Jérôme René; Circiu, Marta P.; Crevier-Buchman, Lise; Hans, Stephane
title: Post-COVID-19 paradoxical vocal fold movement disorder
date: 2020-09-30
journal: Eur Arch Otorhinolaryngol
DOI: 10.1007/s00405-020-06391-z
sha: b32877b0cd18347e5cd8822d35ef9978d03fe02b
doc_id: 722054
cord_uid: hfeva0pz

nan

reflux diagnosis improbable. A videolaryngostroboscopy has been realized, reporting inspiratory and expiratory paradoxical movement of the vocal folds (Video 1). The best way to provoke the vocal fold paradoxical movement was the realization of a sustained vowel. The maximal phonation time was 3 s. There were no additional laryngeal abnormalities. The laboratory testing did not find other infectious diseases (e.g., HZV, HSV, CMV, EBV, HBV, HCV, Influenza, HIV, Syphilis, Mycoplasma Pneumonia).

The patient did not report stress in its life over the past few months and had no apparent psychological disorder. A post-viral Paradoxical vocal fold movement disorder (PVFMD) diagnosis was retained and patient benefited from speech therapy. Four months after the onset of the disorder, the patient recovered after speech therapy. According to the patient clinical history, the development of PVFMD was attributed to the COVID-19.

PVFMD is a rare laryngeal disorder characterized by intermittent constriction of the vocal folds during respiration, stridor and dyspnea [1] . The cause of PVFMD is still unknown [1] . The disease development could be associated with emotional stress, laryngopharyngeal reflux, exercise or neurological nerve impairment [1] . Thus, some data support that the disorder may develop after viral-related laryngeal recurrent nerve impairment [1, 2] . In this paper, we report the case of a young patient who developed PVFMD after COVID-19. The specific mechanism of PVFMD development in the present case remains unknown. The patient did not appear to have other common causes of PVFMD, including reflux, viral infection or psychological stress, which may support a potential association with COVID-19. The potential relationship between both conditions may be strengthened by the neuroinvasive potential of COVID-19 [3] and the vocal fold expression of ACE2 [4] . From a theoretical standpoint, the virus may spread into the tissue by the vocal fold ACE2 and may penetrate into the laryngeal nerve endings. The observation reported in this paper may be useful for otolaryngologists regarding the current pandemic. However, the association between COVID-19 and PVFMD will

Stephane Hans, Lise Crevier-Buchman contributed equally to this work and are co-senior authors.

The online version of this article (https ://doi.org/10.1007/s0040 5-020-06391 -z) contains supplementary material, which is available to authorized users. only be confirmed through future studies including similar patients without comorbidities associated with PVFMD.

Differential diagnosis of paradoxical vocal fold movement

Paradoxical movement of the vocal cord in recurrent laryngeal nerve paralysis

The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients

ACE2 protein landscape in the head and neck region: the conundrum of SARS-CoV-2 infection

Conflict of interest The author had no conflict of interest.Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors.