Epidemiological, clinical and laryngological outcomes and treatments
The following epidemiological and clinical data were collected: demographic information; age; gender; comorbidities; dates/features of documented COVID-19 infection, hospital stay; intubation and tracheostomy; general, voice, swallowing and airway complaints; medical and surgical required treatment and follow-up. The decision of percutaneous tracheostomy was made by intensive care physicians in case of prolonged intubation (>14 days).
The laryngological examination was performed by a senior laryngologist (SH, MC, LCB or JRL) with a videolaryngostroboscopy (XION GmbH, Berlin, Germany). The conclusion of the videolaryngostroboscopy examination was reviewed by a second senior laryngologist in a blind manner according to the initial conclusion. The following laryngeal disorders were considered in the diagnosis: laryngopharyngeal reflux (LPR), laryngeal diffuse edema, posterior commissure hypertrophy, laryngeal necrosis, granuloma, posterior glottic stenosis, subglottic stenosis, and posterior glottic diastasis. The Bogdasarian-Olson classification for stenosis of the posterior glottic membrane,8 and the McCaffrey staging system9 for subglottic and tracheal strictures were used to characterize laryngeal lesions. Patients with a suspicion of LPR and lack of response to medical therapy combining diet, proton pump inhibitors and alginates, benefited from a 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH). According to the laryngeal disorders, the following medical treatments included antibiotics, corticosteroids, proton pump inhibitors (PPIs) and alginate. Patients with no improvement of lesion with medical treatment benefited from surgical treatments, i.e. CO2 laser posterior transverse cordotomy, placement of Montgomery-type laryngeal calibration tube, laser flange (scare), or vocal fold fat injection.