Department of Ear, Nose and Throat Surgery.
Department of Speech and Language Therapy, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Curr Opin Otolaryngol Head Neck Surg. 2021 Dec 1;29(6):437-444. doi: 10.1097/MOO.0000000000000768.
Dysphonia has been described as a major symptom of coronavirus disease-2019 (COVID-19). A literature review examining this topic was undertaken and is presented here, combined with insights from our experience in managing patients with laryngeal complications following mechanical ventilation for severe COVID-19 pneumonitis.
Naunheim et al. reported that patients who are most at risk of needing intubation with COVID-19 disease are those with patient-specific risk factors and these are at an increased risk for subsequent laryngotracheal injury following intubation (1). In our cohort of 105 patients referred with laryngological symptoms postintubation for COVID-19 pneumonitis, 40% presented as urgent reviews, of which almost half had severe postintubation complications requiring surgery. Perceptual voice ratings and patient-reported voice ratings varied widely, but there was no significant change in voice scores postoperatively. The reflux symptom index (RSI) scores did improve significantly (p = 0.0266). The need for surgery was associated with the presence of comorbidities for instance hypertension, diabetes and obesity in our cohort. This is in support of reported association of comorbidity as a risk factor for intubation and subsequent development of postintubation airway complications.
Dysphonia following COVID-19 infection may have multiple causes. Literature reports demonstrate intubation injury, sensory neuropathy, and postviral neuropathy are associated with voice changes. Our personal experience has confirmed postintubation injury markedly affects glottic function with resultant dysphonia attributable to scar formation, posterior glottic stenosis, granulation and subglottic stenosis. Frequent surgical intervention is required for airway patency and may have short-term further deleterious effects on phonation, although in our cohort this is not statistically significant analysing Grade, Roughness, Breathiness, Asthenia, Strain, Voice Handicap Index-10 or Airway, Voice, Swallow scores. Maximal antireflux medications and advice statistically improved RSI scores postoperatively.
新冠肺炎（COVID-19）患者常伴有发音障碍。本文对相关文献进行综述，并结合我们在治疗因 COVID-19 肺炎行机械通气后发生喉并发症患者方面的经验进行阐述。
Naunheim 等人报道，COVID-19 疾病中最需要插管的患者是那些具有特定患者风险因素的患者，这些患者在插管后发生喉气管损伤的风险增加（1）。在我们 105 例因 COVID-19 肺炎行机械通气后出现喉科症状的患者中，40%的患者为紧急会诊，其中近一半患者发生严重的插管后并发症，需要手术治疗。感知性嗓音评估和患者报告的嗓音评估差异很大，但术后嗓音评分无显著变化。反流症状指数（RSI）评分显著改善（p=0.0266）。在我们的队列中，手术的需要与合并症有关，例如高血压、糖尿病和肥胖症。这支持了合并症是插管和随后发生插管后气道并发症的危险因素的报告关联。
COVID-19 感染后发音障碍可能有多种原因。文献报道表明，插管损伤、感觉性神经病和病毒性神经炎与嗓音变化有关。我们的个人经验证实，插管后损伤明显影响声门功能，导致声门瘢痕形成、后声门狭窄、肉芽和下声门狭窄，导致发音困难。需要频繁进行气道通畅性手术干预，这可能会对发音产生短期的进一步有害影响，尽管在我们的队列中，分析等级、粗糙度、呼吸声、无力、紧张、嗓音障碍指数-10 或气道、嗓音、吞咽评分后这并无统计学意义。最大的抗反流药物和建议术后统计学上改善了 RSI 评分。
