Vocal Fold Immobility Following Vaccination

Abstract

Objective: Vocal fold immobility (VFI) may severely affect quality of life due to dysphonia and respiratory distress. Many etiologies of this disorder have been evaluated, however the relationship between VFI and vaccination has yet to be explored. The objective of this study was to identify the relationship between VFI and vaccine administration. Methods: The Vaccine Adverse Event Reporting System (VAERS) database was queried for patients exhibiting symptoms of VFI following vaccination. Patient demographics and clinical information including presenting symptoms, time of symptom onset, laterality, outcomes, and adverse events were documented. Results: Twenty-two patients were found to have VFI following vaccination. Of those reported, 13 patients were female (59.1%) and 8 were male (36.4%) with an average age of 48.4 years. Vaccinations for influenza, shingles, pneumococcus, and hepatitis B were reported. A majority of these cases were unilateral in nature (73.3%). Mean lag time from vaccination to symptom onset was 6.3 days (range 0-45 days). Five adverse events were reported, with 4 patients requiring intubation and tracheostomy. Conclusion: Vaccine administration may be associated with VFI and physicians should be cognizant of this potential adverse event. This is a rare complication with less reported cases than other post-vaccination cranial neuropathies. The difficulty in establishing an initial diagnosis and need for specialized evaluation by an otolaryngologist may result in under-reporting of such events. Further research is needed to delineate the exact pathophysiology of this complication and determine whether a causal relationship exists.

Vocal Fold Paralysis Following COVID-19 Vaccination: Query of VAERS Database

“…Our analysis revealed the majority of cases to be unilateral (78.9%) which is consistent with Talmor et al's finding of 50% unilateral cases of vaccine related paresis [10] and with viral induced VFP, which has largely been reported as unilateral [23]. Our average time from vaccination to symptom onset was 12.1 days, which is longer than those previously described by Talmor et al in VFP patients (6.3 days) and Woo et al in extra-ocular palsies (9 days) [10,24]. However, 84.2% of our patients reported symptoms within 30 days of vaccination which is comparable to 90.0% of patients presenting with VFP [6] and 77% patients presenting with Bell's palsy [25].…”

“…While much of the existing literature regarding adverse reactions to vaccines describes peripheral neuropathy and other cranial neuropathies, there is a paucity of reports on vaccination induced vocal fold paresis. Talmor et al reported on twenty-two patients in the VAERS database found to have VFP following vaccination with influenza, shingles, pneumococcus, and hepatitis B vaccine 10 . Our study represents the first investigation of COVID-19 vaccination associated VFP.…”

“…Vocal cord paralysis or paresis can also occur as a rare complication in the setting of COVID-19 infection and may be due to the neurotoxic effects of SARS-CoV-2 [6][7][8][9]. Though rare, vaccination induced VFP following has also been reported in the literature [10].…”

Vocal fold paralysis following first dose of Oxford-AstraZeneca coronavirus disease 2019 vaccine

“…[11] While most post-viral neuropathies have been linked to acute infections some have been observed after vaccination using the influenza, shingles, pneumococcus, and hepatitis B vaccines. [12] More recent reports have raised a possible temporal association between the administration of the Pfizer-BioNTech and the Oxford-AstraZeneca vaccines and the incidence of Guillain-Barre syndrome and Bell's palsy in vaccinated individuals. [13] - [16] Proposed biological mechanisms which might explain the observed association between the use of mRNA vaccines, such as the Pfizer-BioNTech vaccine, and the imbalance in the incidence of Bell's palsy in the vaccine groups compared to placebo groups, include that mRNA vaccines are associated with a marked type I interferon response which, in some individuals, may trigger and mediate a breakdown of tolerance to myelin sheath antigens leading to autoimmune neuropathy.…”

“…While most post-viral neuropathies have been linked to acute infections, some have been observed after vaccination using the influenza, shingles, pneumococcus and hepatitis B vaccines. 12 More recent reports have raised a possible temporal association between the administration of the Pfizer-BioNTech and the Oxford-AstraZeneca vaccines and the incidence of Guillain–Barré syndrome and Bell's palsy in vaccinated individuals. 13 – 16 …”