Infections including SARS-CoV-2 as triggers for vocal cord dysfunction.

Abstract

Vocal cord dysfunction (VCD) is often under-recognized and/or misdiagnosed as asthma. Although post-viral syndrome has been suggested as a contributing factor in VCD, there is limited data on infection-associated VCD. The purpose of this study was to assess and describe the proportion of patients who were diagnosed with VCD who did and did not report infection preceding VCD diagnosis. Subjects age ≥ 12 years referred for VCD assessment at the time of provocation challenge-rhinolaryngoscopy were enrolled in this prospective study of triggers for VCD registry. Enrollment initiated September 2021. An investigator designed questionnaire of potential triggers for VCD including SARS-CoV-2 was administered with medical data collection using REDCap software platform. Characteristics of subjects with and without respiratory infection-associated VCD were analyzed using Chi-square test and Student’s t-test. Of the 54 subjects analyzed, 57.4% (N=31) reported infection-associated VCD symptoms with either 1) VCD onset following respiratory infection (N=18, 33.3%) or 2) VCD symptoms worsened following SARS-CoV-2 infection (N=13, 24.1%). Subjects with infection-associated and non-infection-associated VCD otherwise shared largely similar characteristics. There were more subjects being age greater than 40 years in the infection-associated group (p=0.027) and this group also reported more throat clearing (p=0.019). Our results suggest a role for infectious etiologies, including SARS-CoV-2, in triggering and/or worsening VCD. VCD should be considered in the differential diagnosis of protracted shortness of breath following SARS-CoV-2 and other respiratory infections.