COVID-19 Omicron variant-induced laryngitis

Abstract

Objectives: The COVID-19 omicron variant has a low affinity for the lower respiratory tract. However, upper respiratory tract symptoms, such as nasal discharge and sore throat, characterize the infection with this variant. Therefore, in laryngeal stenosis, disease severity assessment through blood oxygen saturation has not been useful.

Methods: We report the case of "omicron laryngitis" in a 59-year-old male who visited the ear, nose, and throat (ENT) clinic with complaints of a sore throat and difficulty in swallowing saliva that persisted for a day.

Results: Laryngoscopy revealed severe swelling of the transglottic region and exudates on the larynx. He was then diagnosed with COVID-19 and subjected to emergency tracheostomy for airway management. Until the emergence of the omicron variant, COVID-19 showed mainly lower airway and mild upper airway inflammatory features. However, upper airway stenosis should be suspected in cases presenting with "muffled speech," "dysphagia," "severe pain on swallowing," and "inspiratory dyspnea or stridor."

Conclusion: Therefore, laryngeal and pharyngeal evaluation using a flexible laryngoscope under appropriate infection control measures is necessary, considering the possibility of progression to fatal laryngeal stenosis, as noted in this case.

Keywords: Airway management; COVID-19; Laryngitis; Tracheostomy; Upper airway stenosis.

Figure 1

Laryngoscopic findings. The larynx and hypopharynx displayed erythema and edema with salivary retention, reflecting dysphagia. Swelling and erosion formed from the glottis to the subglottis, and the airway was constricted.

Figure 2

Chest CT scan showed peripheral ground glass opacities in the right S6 and left S5 (arrows), indicating COVID-19 pneumonia.

Figure 3

Histopathological findings. The subepithelial stroma showed stratified inflammatory cell infiltrates comprising neutrophils, lymphocytes, and plasma cells.