Effect of COVID-19 on the incidence of postintubation laryngeal lesions.

Background: Critically ill patients intubated in the intensive care unit experience prolonged intubation leading to increased frequency of laryngeal injuries. This study aimed to demonstrate a suspected increase in vocal fold injury in patients who were intubated with COVID-19 as compared with patients intubated for other reasons. Methods: A retrospective review of medical records was performed to identify patients examined using flexible endoscopic evaluation of swallowing exams. The study included 25 patients with COVID-19 and 27 without COVID-19 at Baylor Scott & White Medical Center in Temple, Texas. Various injuries were evaluated, ranging from granulation tissue to vocal cord paralysis. Severe lesions were those causing clinically significant airway obstruction or requiring operative intervention. The incidence of laryngeal injury in patients intubated for COVID-19 was then compared with that of patients intubated for other reasons. Results: The increased presence of severe injury in COVID-positive patients appeared clinically significant but was not statistically significant (P = 0.06). Interestingly, patients who received pronation therapy had 4.6 times the odds of more severe injury compared with patients who did not (P = 0.009). Conclusion: Lower thresholds for performing flexible laryngoscopy on postintubated patients who are proned may allow for earlier intervention and reduce morbidity in an already at-risk population.

Retropharyngeal abscess in the setting of multisystem inflammatory syndrome in children.

Multisystem inflammatory syndrome in children (MIS-C) is a potentially severe inflammatory syndrome following recent infection with SARS-CoV-2 (COVID-19). In this report, we describe a 13-year-old boy with a retropharyngeal abscess unresponsive to initial antibiotic therapy who was found to have findings consistent with MIS-C, which included elevated interleukin-6, ferritin, and troponin levels. The patient had COVID-19 infection due to the Omicron variant.

Breakthrough COVID-19 infection inducing acute epiglottitis in an immunized host.

We present the case of a 32-year-old man vaccinated with the Johnson & Johnson coronavirus disease 2019 (COVID-19) vaccine who presented with pharyngodynia and breakthrough COVID-19 infection. The patient was diagnosed with severe acute respiratory syndrome coronavirus 2 infection via nasal swab and acute epiglottitis by imaging and flexible laryngoscopy. While COVID-19 is known to present with pharyngodynia, nasal congestion, rhinorrhea, and olfactory dysfunction, epiglottitis is not a typical presentation. Fewer than 10 cases of acute epiglottitis in the setting of COVID-19 have been reported. Independently, active COVID-19 infections can result in acute respiratory distress syndrome, while epiglottitis may lead to complete airway obstruction. The combination of these two conditions may lead to challenging clinical management.