Sudden and persistent dysphonia within the framework of COVID-19: The case report of a nurse

Vocal Signs and Symptoms Related to COVID-19 and Risk Factors for their Persistence

OBJECTIVE

To compare the occurrence of vocal signs and symptoms before, during, and after coronavirus disease (COVID-19) and analyze possible risk factors for the persistence of these signs and symptoms after disease resolution.

METHODS

This was an observational, analytical, and cross-sectional study. The participants were 45 individuals of both sexes, with a mean age of 44 years, who were previously affected by COVID-19. All participants answered a questionnaire about sociodemographic data, smoking history, disease course, vocal complaints, and the vocal signs and symptoms list (SSL), referring to three timepoints (before, during, and after COVID-19).

RESULTS

The most commonly reported vocal signs and symptoms before COVID-19 were phlegm (26.67%; n=12) and dry throat (24.44%; n=11). During COVID-19, the most frequent vocal signs and symptoms were tired voice after short-term use (73.33%; n=33) and dry throat (71.11%; n=32). After the disease, the most reported vocal signs and symptoms were dry throat (57.78%; n=26) and phlegm (53.33; n=24). The self-perception of vocal signs and symptoms before COVID-19 was lower than that during and after COVID-19 (P < 0.001). Vocal complaints after COVID-19 and oxygen therapy were predictors of self-perception of vocal signs and symptoms after COVID-19.

CONCLUSIONS

Individuals affected by COVID-19 had a higher frequency of vocal signs and symptoms during the disease. However, after remission, the frequency of vocal signs and symptoms was higher than that at baseline. The need for oxygen therapy may indicate a risk for a higher occurrence of vocal signs and symptoms after COVID-19.

Persistent Dysphonia in Hospitalized COVID-19 Patients

INTRODUCTION

The main objective of this study is to estimate the prevalence of persistent dysphonia in hospitalised COVID-19 patients.

METHODS

Data were collected from those COVID-19 patients who, during the months of March to April 2020, were hospitalised in ward or intensive care unit at the University Hospital of Fuenlabrada. Patients with dysphonia prior to SARS-CoV-2 were excluded. Informed consent was obtained orally by a telephone call, as well as clinical and epidemiological data. Patients who reported persistent dysphonia were assessed using the Voice Handicap Index 10, the maximum phonation time, the s/z ratio and a fibrolaryngoscope examination. Patients who reported persistent dysphagia were assessed with the Eating Assessment Tool 10.

RESULTS

A total of 79 patients were included in the study (48 men and 31 women). 10 ICU patients (25%) and 4 ward patients (10,3%) had dysphonia at least 3 months after hospital discharge, but no association was found between ICU admission and the presence of persistent dysphonia (P = 0.139). Persistent dysphonia in patients admitted to the ICU is associated with persistent dysphagia (P = 0.002), also the age of patients with persistent dysphonia is significantly higher than the age of non-dysphonic patients (P = 0.046). The most frequent exploratory finding was vocal cord paresis/paralysis (60.4%).

CONCLUSION

This is one of the first studies to show that persistence of dysphonia may be a consequence of COVID-19, so further studies are needed to assess the evolution and prognosis of these patients and the possible association of dysphonia with the severity of the disease.

Somatic symptoms associated with mental distress during the COVID-19 pandemic: a systematic review

OBJECTIVE

The primary objective of this article was to systematically review the prevalence of somatic symptoms in patients, healthcare workers and general population during the COVID-19 pandemic. The secondary objectives were to record the association between somatic symptoms and indices of mental distress and to record the qualitative characteristics of such somatic complaints.

METHODS

Following the PRISMA methodology we systematically searched PubMed, Scopus and Google Scholar for primary research reporting on somatic symptoms in association with mental distress. We specifically sought papers reporting on bodily distress disorder, somatic symptoms disorder or medically unexplained symptoms.

RESULTS

1569 papers were retrieved, which yielded 36 relevant studies after screening. 15 studies referred to healthcare workers, 13 to general population, 5 to COVID-19 patients, 2 compared medical with non-medical professionals and 1 was studying COVID-19 patients some of which were also healthcare workers. The reported prevalence of somatic symptoms ranged from 7.4% to 67.8%. Commonly seen symptoms were shortness of breath, dyspnea, palpitations and pain in arms, legs and joints.

CONCLUSIONS

Our systematic review suggests that somatic symptoms are very frequent during the pandemic and are often linked to mental distress. All three population groups are affected.

[Voice disorders associated with novel coronavirus infection]

OBJECTIVE

To evaluate the features of voice disorders associated with novel coronavirus infection and to develop the clinical algorithm for diagnostic and treatment these patients.

MATERIAL AND METHODS

A prospective observational study was conducted in patients with dysphonia after COVID-19 (n=60). All patients underwent a comprehensive voice assessment before and after the proposed treatment. The follow-up period was 1 month.

RESULTS

Functional dysphonia or aphonia with a stable (refractory) or recurrent course was diagnosed in 58 (97%) patients. A tendency to an increase in the value of the latent period of the P300 and MMN in patients with voice disorder was revealed. There was a significant decrease in supraglottic constriction and glottal insufficiency before and after the treatment. The mean VHI-10 decreased from 25.4 before treatment to 15.3 after treatment. The DSI which is based on the set of voice measurements, statistically significant improved from -5.2 to 2.6 in patients as a result of treatment. The average value of MFI-20 improved from 65.4 (8.7) at the beginning of the study to 20.3 (5.3) after treatment.

CONCLUSION

In patients with dysphonia or aphonia associated with COVID-19 are indicated a refractory type of dysphonia. This was indicated by the study of AEPs of the brain. The clinical algorithm for treatment and diagnostic patients with voice disorders after COVID-19 has been developed. The treatment of this group of patients should be adjunct by the drug therapy, kinesiotaping method and psychotherapy.

Persistent or new symptoms 1 year after a single high dose of vitamin D3 in patients with moderate to severe COVID-19

Purpose

The aim of this study was to investigate the reported persistent or new symptoms 1 year after a single dose of 200,000 IU of vitamin D₃ and hospitalization in patients with moderate to severe COVID-19.

Methods

This is a post-hoc, exploratory analysis from a multicenter, double-blind, placebo-controlled, randomized clinical trial from two hospitals in São Paulo, Brazil, registered in ClinicalTrials.gov, NCT04449718. Discharged patients were followed for up to 1 year and evaluated by telephone interviews at 6 and 12 months. The primary and secondary outcomes were previously published. These post-hoc exploratory secondary outcomes are the persistent or new symptoms and quality of life (QoL) at the post-viral stage of COVID-19. Generalized estimating equations (GEE) for repeated measures with Bonferroni’s adjustment were used for testing outcomes.

Results

Between 2 June and 27 August 2020, we randomized 240 patients of which 144 were included in this study [the vitamin D₃ (n = 71) or placebo (n = 73) group]. The mean (SD) age was 54.3 (13.1) years, and body mass index (BMI) was 32.4 (6.5) kg/m². Fever demonstrated a significant main effect of time (P < 0.001) with a reduction from baseline to 6 (52–0) and 12 months (52–0). No significant differences between groups were observed for fever, cough, fatigue, fever, myalgia, joint pain, runny nose, nasal congestion, sore throat, hypertension, diabetes, cardiovascular disease, rheumatic disease, asthma, chronic obstructive pulmonary, chronic kidney disease, QoL, and new or persistent symptoms up to 1-year of follow-up.

Conclusion

The findings do not support the use of 200,000 IU of vitamin D₃ compared to placebo for the management of persistence or new symptoms, and QoL reported by moderate to severe patients after hospitalization for COVID-19.

Isolated Severe Dysphonia as a Presentation of Post-COVID-19 Syndrome

This is the first study assessing the clinical management of severe, isolated dysphonia during post-COVID-19 syndrome. One hundred and fifty-eight subjects met the inclusion criteria for the post-COVID-19 condition as specified by the WHO. Six patients were diagnosed with isolated severe dysphonia, constituting 3.8% of the initial group. The pre- and post-examination protocol consisted of subjective voice self-assessment and routine laryngological examination, followed by an instrumental examination by means of Laryngovideostroboscopy (LVS) and High-Speed Videolaryngoscopy (HSV). The treatment included short-term systemic steroids in decreasing doses, moisturizing inhalations with hyaluronic acid, and protective agents against Laryngopharyngeal Reflux. The kinematic imaging of the glottis performed by means of HSV before treatment showed deviations in the regularity and symmetry of vocal fold vibrations, absence of mucosal wave, and incomplete glottal closure. Improvement of the structural and functional state of the larynx was observed post-treatment. Kymographic sections and Glottal Width Waveform (GWW) graphs obtained from post-treatment HSV recordings showed improvement in vocal fold vibrations. The decrease in mean Jitter and Shimmer was observed, with the following mean values of 3.16 pre-treatment and 2.97 post-treatment for Jitter and 7.16 pre-treatment and 2.77 post-treatment for Shimmer. The post-treatment self-evaluation of voice showed considerable improvement in vocal function and voice quality in all the examined patients. Severe dysphonia in patients with post-COVID-19 syndrome requires urgent ENT diagnosis using instrumental assessment with the evaluation of laryngeal phonatory function and intensive comprehensive treatment.

Quarantine and Mental Health Challenges for Occupational Medicine: The Case Report of a Nurse Infected With SARS-CoV-2

This case study draws attention to the psychosocial difficulties that emerged in the context of the coronavirus disease 2019 (COVID-19) outbreak in relation to the remote management of subjects with psychiatric vulnerabilities following exposure to prolonged quarantine. The case involves a 56-year-old hospital nurse, followed by the Occupational Health Department of a major university hospital in central Italy for mood instability in the context of a cyclothymic temperament. She was quarantined for occupationally acquired COVID-19 and remained positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via swab test for more than 2 months between March and May 2020. In this case study, we discuss the challenges presented by the risk of a prolonged quarantine in a psychologically vulnerable employee, the need for occupational medicine to provide adequate health surveillance of all health care workers during the COVID-19 pandemic, the effectiveness of telepsychiatry, and the difficulties in formulating a proper treatment strategy.

Patient reported voice handicap and auditory-perceptual voice assessment outcomes in patients with COVID-19

PURPOSE

The purpose of this study is to compare patient-reported voice handicap and auditory-perceptual measures of voice between healthy individuals and COVID-19 patients, as well as to investigate the effect of clinical factors on voice quality.

METHODS

COVID-19 patients (n = 138) and 90 healthy controls were included in the study. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was used to grade voice samples based on overall severity, roughness, breathiness, strain, pitch, and loudness. The Voice Handicap Index-10 was completed by all participants (VHI-10). Physical (pVHI), emotional (eVHI) and functional (fVHI) subscores were calculated. Clinical data were collected (disease stage, CT grade, neutrophil/lymphocyte ratio, CRP, and symptoms).

RESULTS

A statistically significant difference between patient and control groups in VHI-10 and CAPE-V scores was detected (p < 0.001). Except eVHI, total score and all subscale scores were higher in patients with COVID-19 as the pVHI was the most affected (η² = 0.324) subscale. All scores of CAPE-V were significantly worse in patients with COVID-19 as highest impact of COVID-19 was on breathiness (η² = 0.518). Pre-existing pulmonary comorbidity_, dyspnoea and N/L was significantly associated with the VHI-10 overall score (β_pc = 4.27, β_dyspnoea = 5.69 and β_nl = 0.25). The overall severity of CAPE-V was significantly dependent on dyspnoea and pulmonary comorbidity (β_dyspnoea = 11.25, β_pc = 10.12). VHI ≥4 and CAPE-V overall severity ≥11 were good indicators of COVID-19 related dysphonia.

CONCLUSIONS

COVID-19 causes patient-reported voice handicap and deteriorates auditory-perceptual measures of voice. COVID-19 related voice impairment was mainly associated with the decreased respiratory capacity.

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

Background

Dysphonia is a feature of the COVID-19 disease with different prevalence rates of occurrence among various nations.

Objectives

To determine the prevalence of dysphonia in hospitalized patients with COVID-19 disease.

Materials and methods

The study was conducted at Salahaddin General Hospital during the period from January to March 2021. Hospitalized COVID-19 patients with or without dysphonia were enrolled in the study. Demographic and clinical data were recorded. The severity, duration, laryngoscopic finding, and fate of the dysphonia were registered too.

Results

Out of 94 subjects, there were 21 (22.3%) with dysphonia. The age was ranged from 23 to 101 years, with nearly equal gender distribution. Non-smokers were found in 52.1% of the cases. Dyspnea (100%), fever (100%), and cough (98.9%) were the most common presenting symptoms. There was a statistically significant difference between the dysphonic and non-dysphonic groups regarding fatigue, nasal obstruction, and diarrhea (P-value<0.05). Mild dysphonia was found in 10 (47.6%) of the dysphonic cases. The most common laryngoscopic finding was the bowing of the vocal cords (5/18). Most of the patients (11/18) were with dysphonia for more than a month duration. Similar numbers were not recovered for a one-month follow-up.

Conclusion

The prevalence of dysphonia was 22.3%. Dyspnea, fever, and cough were the commonest symptoms. Fatigue, nasal obstruction, and diarrhea affected dysphonia. Bowing of the vocal cords was the most common abnormality. Most of the cases were with mild dysphonia, persisting for more than a month, and were not resolved during the follow-up period of one month.

Vocal Disorders in Patients with COVID 19 in Egypt

COVID-19 is considered a respiratory disease which has many symptoms associated with the larynx and the lungs infections. COVID-19 has wide spectrum of clinical features starting from mild symptoms to severe illness. Otolaryngological symptoms as nasal obstruction, loss of smell, taste dysfunction, sore throat, sticky mucus, and dysphagia are common in COVID-19 patients. Other vocal symptoms as dysphonia and phonesthenia are common in COVID-19 patients. The aim of this study is to detect the occurrence of vocal symptoms in COVID-19 patients in Egypt and to investigate the videolaryngoscopic findings associated with these symptoms. A total number of 106 patients diagnosed with COVID-19 were randomly assessed for vocal symptoms. The following epidemiological and clinical data were collected: age, gender, smoking consumption, general symptoms, otolaryngological and vocal symptoms as dysphonia and phonesthenia. Auditory perceptual assessment of voice and videolaryngoscopic examination were done. The occurrence of dysphonia and phonesthenia were observed in COVID -19 patients. Of the 106 patients, 84 patients (79%) were dysphonic, 20 (18.8%) patients were phonesthenic. The correlation of the different otolaryngological symptoms with dysphonia and phonesthenia were reported. A significant correlation was found between dysphonic patients and rhinorrhea, taste dysfunction, sore throat, and cough. A significant correlation was found between phonesthenic patients and allergic rhinitis. Videolaryngoscopic findings were detected in COVID-19 patients. Vocal fold congestion was found in 42 patients (39.6%), benign vocal fold swellings was found in 18 patients (16.9%), ventricular hypertrophy was found in 6 patients (0.05%), unilateral vocal fold immobility was found in 14 patients (13.2%), and vocal fold congestion associated with ventricular fold hypertrophy was found in 20 patients (18.8%).There was significant correlation of dysphonia and phonesthenia with vocal fold congestion (P value:0.001, P value:0.039 respectively).There was a significant correlation between cough and vocal fold congestion (P value: 0.000). Benign vocal fold swellings were associated with 18 patients (16.9%), but it was not statistically significant (P value: 0.931). Dysphonia and phonesthenia were observed in patients with mild to moderate COVID-19.The vocal symptoms were associated with different laryngoscopic findings, in which, vocal fold congestion was the commonest.

Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data

Whilst the entire world is battling the second wave of COVID-19, a substantial proportion of patients who have suffered from the condition in the past months are reporting symptoms that last for months after recovery, i. e., long-term COVID-19 symptoms. We aimed to assess the current evidence on the long-term symptoms in COVID-19 patients. We did a systematic review on PubMed, Web of Science, EMBASE, and Google Scholar from database inception to February 15, 2021, for studies on long-term COVID-19 symptoms. We included all type of papers that reported at least one long-term COVID-19 symptom. We screened studies using a standardized data collection form and pooled data from published studies. Cohort cross-sectional, case-report, cases-series, case-control studies, and review were graded using specific quality assessment tools. Of 11,361 publications found following our initial search we assessed 218 full-text articles, of which 145 met all selection criteria. We found that 20.70% of reports on long-term COVID-19 symptoms were on abnormal lung functions, 24.13% on neurologic complaints and olfactory dysfunctions, and 55.17% on specific widespread symptoms, mainly chronic fatigue, and pain. Despite the relatively high heterogeneity of the reviewed studies, our findings highlighted that a noteworthy proportion of patients who have suffered from SARS-CoV-2 infection present a "post-COVID syndrome." The multifaceted understanding of all aspects of the COVID-19 pandemic, including these long-term symptoms, will allow us to respond to all the global health challenges, thus paving the way to a stronger public health.

COVID-19 survivorship: How otolaryngologist-head and neck surgeons can restore quality of life after critical illness

Mortality from COVID-19 has obscured a subtler crisis – the swelling ranks of COVID-19 survivors. After critical illness, patients often suffer post-intensive care syndrome (PICS), which encompasses physical, cognitive, and/or mental health impairments that are often long-lasting barriers to resuming a meaningful life. Some deficits after COVID-19 critical illness will require otolaryngologic expertise for years after hospital discharge. There are roles for all subspecialties in preventing, diagnosing, or treating sequelae of COVID-19. Otolaryngologist leadership in multidisciplinary efforts ensures coordinated care. Timely tracheostomy, when indicated, may shorten the course of intensive care unit stay and thereby potentially reduce the impairments associated with PICS. Otolaryngologists can provide expertise in olfactory disorders; thrombotic sequelae of hearing loss and vertigo; and laryngotracheal injuries that impair speech, voice, swallowing, communication, and breathing. In the aftermath of severe COVID-19, otolaryngologists are poised to lead efforts in early identification and intervention for impairments affecting patients' quality of life.

Persistent positivity of SARS-CoV-2 nucleic acid in asymptomatic healthcare worker: infective virion or inactive nucleic acid?

Asymptomatic individuals positive for SARS-CoV-2 RNA constitute a significant proportion of the infected population and play a role in the transmission of the virus. We describe a healthcare worker who presented with fever and malaise and was diagnosed with mild COVID-19. The symptoms resolved within 4 days but there was persistent positivity of viral RNA in the upper respiratory tract for more than 58 days, which is the longest reported duration of persistence of SARS-CoV-2 in a healthcare worker. In this case report, we discuss clinical and administrative issues such as the role of asymptomatic cases in the transmission of the virus to patients and coworkers as an occupational hazard, interpretation of persistent positivity of nucleic acid test, duration of isolation and return-to-work guidelines pertinent to researchers and global health policymakers.