J Korean Med Sci.  2022 Jun;37(25):e201. 10.3346/jkms.2022.37.e201.

Bilateral Vocal Fold Paralysis After COVID-19 mRNA Vaccination: A Case Report

• Son SA
• Kim YJ
• Lim SY
• Kim HB

• KMID: 2530836
• DOI: http://doi.org/10.3346/jkms.2022.37.e201

Abstract

Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was noted to cause coronavirus disease 2019 (COVID-19) in 2019, there have been many trials to develop vaccines against the virus. Messenger ribonucleic acid (mRNA) vaccine as a type of the vaccine has been developed and commercialized rapidly, but there was not enough time to verify the long-term safety. An 82-year-old female patient was admitted to the emergency room with dyspnea accompanied by stridor three days after the 3rd COVID-19 mRNA vaccination (Comirnaty, Pfizer-BioNTech, USA). The patient was diagnosed with bilateral vocal fold paralysis (VFP) by laryngoscope. Respiratory distress was improved after the intubation and tracheostomy in sequence. The brain, chest, and neck imaging tests, serological tests, cardiological analysis, and immunological tests were performed to evaluate the cause of bilateral VFP. However, no definite cause was found except for the precedent vaccination. Because bilateral VFP can lead to a fatal condition, a quick evaluation is necessary in consideration of VFP when dyspnea with stridor occurs after vaccination.

Keyword

Vocal Paralysis; Vocal Palsy; COVID-19 Vaccine; mRNA Vaccine

Reference

1. Vetter V, Denizer G, Friedland LR, Krishnan J, Shapiro M. Understanding modern-day vaccines: what you need to know. Ann Med. 2018; 50(2):110–120. PMID: 29172780.

2. Anand P, Stahel VP. Review the safety of Covid-19 mRNA vaccines: a review. Patient Saf Surg. 2021; 15(1):20. PMID: 33933145.

3. Shang W, Yang Y, Rao Y, Rao X. The outbreak of SARS-CoV-2 pneumonia calls for viral vaccines. NPJ Vaccines. 2020; 5(1):18. PMID: 32194995.

4. Wang Y, Zhang Z, Luo J, Han X, Wei Y, Wei X. mRNA vaccine: a potential therapeutic strategy. Mol Cancer. 2021; 20(1):33. PMID: 33593376.

5. Kadali RA, Janagama R, Yedlapati SH, Kanike N, Gajula V, Madathala RR, et al. Side effects of messenger RNA vaccines and prior history of COVID-19, a cross-sectional study. Am J Infect Control. 2022; 50(1):8–14. PMID: 34718069.

6. Gargano JW, Wallace M, Hadler SC, Langley G, Su JR, Oster ME, et al. Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients: update from the advisory committee on immunization practices - United States, June 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(27):977–982. PMID: 34237049.

7. Ahsanuddin S, Nasser W, Roy SC, Povolotskiy R, Paskhover B. Facial paralysis and vaccinations: a vaccine adverse event reporting system review. Fam Pract. 2022; 39(1):80–84. PMID: 34184737.

8. Hamdi OA, Jonas RH, Daniero JJ. Vocal fold paralysis following COVID-19 vaccination: query of VAERS database. J Voice. Forthcoming. 2022; DOI: 10.1016/j.jvoice.2022.01.016.

9. Lehrer E, Jubés S, Casanova-Mollà J. Vocal fold palsy after vaccination against SARS-CoV-2. Med Clin (Barc). Forthcoming. 2022; DOI: 10.1016/j.medcli.2021.12.013.

10. Stager SV. Vocal fold paresis: etiology, clinical diagnosis and clinical management. Curr Opin Otolaryngol Head Neck Surg. 2014; 22(6):444–449. PMID: 25254404.

11. Talmor G, Nguyen B, Din-Lovinescu C, Paskhover B, Kaye R. Vocal fold immobility following vaccination. Ann Otol Rhinol Laryngol. 2021; 130(6):609–613. PMID: 33063519.

12. Vaira LA, Salzano G, Deiana G, De Riu G. Anosmia and ageusia: common findings in COVID-19 patients. Laryngoscope. 2020; 130(7):1787. PMID: 32237238.

13. Butowt R, von Bartheld CS. Anosmia in COVID-19: underlying mechanisms and assessment of an olfactory route to brain infection. Neuroscientist. 2021; 27(6):582–603. PMID: 32914699.

14. Nepal G, Rehrig JH, Shrestha GS, Shing YK, Yadav JK, Ojha R, et al. Neurological manifestations of COVID-19: a systematic review. Crit Care. 2020; 24(1):421. PMID: 32660520.

15. Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci. 2020; 11(7):995–998. PMID: 32167747.