Case series/case reports (Indigo)
In this article the authors report the case of a 72-year-old man admitted to the hospital with COVID-19 pneumonia. The neurological history and exam were unremarkable. Due to respiratory worsening, oro-tracheal intubation and repeated courses of pronation became mandatory after 1 week. As gas exchanges improved, the patient weaned from the ventilator and self-extubated after 14 days. The day after, a bedside fibro-endoscopic evaluation of swallowing documenting poor control of the oral and oropharyngeal phases, laryngeal penetration, and inhalation by gravity. Bedside FEES was repeated after one month, but despite a substantial improvement of the oral and oropharyngeal phases, the patient still presented inhalation for solids and liquids. The bronchoscope touch induced neither laryngeal sensitivity nor cough refex, and the instrument could easily cross vocal folds configuring a neurosensory dysphagia. Absolute fasting was confirmed, and percutaneous endoscopic gastrectomy (PEG) was suggested. The authors suggest that early evaluation of swallowing is mandatory in COVID-19 extubated patients to recognize possible neurological damage (and consequent slower recovery) and in their opinion, the best timing for FEES could be 7–10 days after the extubation of COVID-19 patients. In this time window, most dysphagia causes resolve spontaneously (i.e., laryngeal paresis, pressure ulcers), and the virus clearance might be complete.
Zanon A, Cacciaguerra L, Martelli G, Filippi M. Neurosensory dysphagia in a COVID-19 patient. J Neurol. 2021 Apr 19:1–3. doi: 10.1007/s00415-021-10541-6. Epub ahead of print. PMID: 33876325; PMCID: PMC8055053