The percentage of patients diagnosed with COVID-19 who develop self-reported symptoms of olfactory dysfunction has been reported between 60% to 80% in multiple studies. That’s significantly higher than prior viral upper respiratory infections. —Abtin Tabaee, MD
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January 2021
Respiratory retraining involves increased resistance breathing exercises and is usually administered by a speech-language pathologist (SLP). However, not all SLPs are familiar with or trained to conduct respiratory retraining. Your nearest academic medical center may be able to point you toward SLPs who offer respiratory retraining, which can be delivered virtually.
A low-acid diet, or one that avoids foods with a pH less than 4, does not aggravate the vagus nerve, Dr. Aviv said, and may allow it to heal. Foods to avoid include flavored sodas, bottled iced teas, citrus fruits, tomato sauce, vinegar, and wine.
Otolaryngologists should inform their pulmonary colleagues that shortness of breath and cough after likely COVID-19 infection may be caused by vagal neuropathy. A collaborative approach is necessary to ensure that patients access effective treatment.
Laryngotracheal Stenosis
Some severely ill COVID-19 patients require prolonged mechanical ventilation. If mechanical support is needed beyond a week or so, a tracheotomy may be performed to facilitate ventilation. Long-term endotracheal intubation and tracheostomy are known to increase the risk of laryngotracheal stenosis (LTS), granulomas, and tracheo-esophageal fistulae. In the summer of 2020, European otolaryngologists warned that “it is highly probable that in the future months and years, otolaryngologists will be called to manage an increasing number of LTS due to the worldwide emerging issues related to the COVID-19 pandemic” (Eur Arch Otorhinolaryngol [published online ahead of print June 6, 2020] doi: 10.1007/s00405-020-06112-6).
To date, U.S. physicians have yet to notice a surge of patients with LTS. “We’re not yet seeing a lot of stenoses at the site of the trach or as a result of intubation,” said Dr. Tassler. “That doesn’t mean it won’t come.”
The European Laryngological Society recommended in July that “every patient with a history of a COVID-19-related ICU stay should be followed after discharge by an otolaryngologist or other airway specialist to proactively diagnose early complications at the level of the larynx and trachea” (ibid). Given what otolaryngologists have since learned about smell and taste alterations and persistent shortness of breath and cough after COVID-19 infection, it seems prudent that all patients experiencing continued symptoms consult an otolaryngologist.
Otolaryngologists will have to educate the public (as well as their colleagues in other disciplines) about the essential role they can play in the diagnosis and management of post-COVID-19 complications.