A 59-year-old man presented to the emergency department with recent onset biphasic stridor, dyspnoea and increased work of breathing on the background of prolonged intubation for the novel COVID-19 2 months previously. Flexible laryngoscopy revealed bilateral vocal fold immobility with a soft tissue mass in the interarytenoid region. The patient’s symptoms improved with oxygen therapy, nebulised epinephrine (5 mL; 1:10 000) and intravenous dexamethasone (3.3 mg). The following morning, the patient was taken to theatre, underwent suspension microlaryngoscopy and found to have bilateral fixation of the cricoarytenoid joints and a large granuloma in the interarytenoid area. He underwent cold steel resection of the granuloma and balloon dilatation between the arytenoids, with the hope of mobilising the joints. This failed and CO2 laser arytenoidectomy was performed on the left side. The stridor had resolved postoperatively, with normalisation of work of breathing and the patient was discharged home on the first postoperative day.

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Underestimating the true impact of obesityThe ever-increasing burden that obesity exerts on population health was recently explored in The Lancet Public Health by Solja Nyberg and colleagues. 1 The authors measured the loss of diseasefree years attributable to major noncommunicable diseases (NCDs) in obese adults compared with those who were normal weight. Individuals lost 3-4 more disease-free years if they were mildly obese and 7-8 more disease-free years if they were severely obese. These results show the alarming extent of obesity's impact on health; however, the true effect is likely to be even higher than reported.The decision to use the six commonest NCDs could have led to an underestimation of the true effect size because obesity contributes a large morbidity burden through diseases not included in their analysis, such as musculoskeletal conditions and depression. 2 Lower back pain has been extensively linked to increased bodymass index 3 and is the leading cause of disability-adjusted life-year loss globally. 4 Furthermore, as shown by the authors, the effect of their chosen conditions, particularly type 2 diabetes, was likely to be underestimated as only data from hospital and death registries were used. This data selection omits the huge burden of obesity-associated morbidity that exists solely in primary care. 5 It also could explain part of the considerable difference in disease-free years lost between mild and severe obesity; co-morbid conditions suffered by those with mild obesity are less likely to be severe enough to require inpatient management.The effect of obesity through NCDs is likely to be more alarming than reported and this effect permeates through all social classes. More must be done through public health policy to tackle all levels of obesity.We declare no competing interests.