Vocal Cord Ulcer Following Endotracheal Intubation for Mechanical Ventilation in COVID-19 Pneumonia: A Case Report from Northern Italy

Objective: Diagnostic/therapeutic accidents Background: This report is of a case of vocal cord ulceration following endotracheal intubation and mechanical ventilation in a patient with severe COVID-19 pneumonia. Case Report: A 57-year-old woman was admitted to our hospital (Ospedale Degli Infermi, Biella, Italy) presenting with symptoms of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Reverse transcription realtime polymerase chain reaction from a nasopharyngeal swab, authorized and validated by the World Health Organization, confirmed the diagnosis of SARS-CoV-2 infection. The patient presented with severe respiratory distress and underwent orotracheal intubation for mechanical ventilation. She was extubated after 9 days in the intensive care unit. After extubation, the patient experienced an onset of dysphonia, and was evaluated by the otolaryngologist. The videolaryngoscopy revealed the presence of an ulceration at the level of the left vocal cord. Steroids and proton pump inhibitors were administered as primary therapy for 1 week. Two weeks later, a significant improvement in the patient's voice quality was observed. A second videolaryngoscopy was performed, which displayed healing of the ulcer at the level of the left vocal fold and rapid re-epithelialization. Conclusions: This report has shown that with increasing numbers of cases of severe COVID-19 pneumonia requiring endotracheal intubation and mechanical ventilation, clinical guidelines should be followed to ensure that the incidence of complications such as vocal cord ulceration are as low as possible.