Laryngeal Dysfunction Following COVID-19: A TriNetX Retrospective Cohort Study.

Abstract

Long COVID affects multiple organ systems, yet the incidence and risk factors for post-COVID-19 laryngeal dysfunction remain underexplored. This study evaluated the incidence of laryngeal dysfunction following COVID-19. A retrospective cohort study was performed using the TriNetX Global Collaborative EHR Network (> 180 million records). Adults without prior laryngeal dysfunction or major comorbidities were stratified by COVID-19 exposure and compared with uninfected controls. Outcomes included chronic cough, dysphagia, voice disorders, vocal fold paralysis, and laryngeal spasm, assessed up to 5 years post-infection. After propensity score matching, odds ratios (OR) and risk differences (RD) with 95% confidence intervals (CI) were calculated. COVID-19 was associated with significantly increased odds of chronic cough (peak OR 7.12; RD 0.33%, p < 0.0001), dysphagia (peak OR 2.71; RD 0.36%, p < 0.0001), voice disorders (peak OR 3.25; RD 0.12%, p < 0.0001), vocal fold paralysis (peak OR 2.17; RD 0.01%, p < 0.0001), and laryngeal spasm (peak OR 2.79; RD 0.003%, p < 0.0001). Incidence peaked at 1-2 years for most outcomes and at 2-3 years for laryngeal spasm. Hospitalization and mechanical ventilation were associated with increased rates of dysphagia (HR 2.63; HR 5.26), voice disorders (HR 1.15; HR 4.45), and vocal cord paralysis (HR 2.09; HR 9.35), but reduced rates of chronic cough (HR 0.68; HR 0.45). Vaccinated patients showed higher rates of chronic cough (HR 1.36) and voice disorders (HR 1.22). COVID-19 is associated with increased incidence of new-onset laryngeal dysfunction, most commonly peaking 1-2 years after infection and influenced by hospitalization, mechanical ventilation, and vaccination status.