Objective: To investigate post-intubation laryngeal complications in severe COVID-19 patients. Methods: From September 2020 to April 2021, consecutive patients presenting with laryngological symptoms following severe COVID-19 infection and related intubation were included. Demographic, age, gender, comorbidities, symptoms, intubation duration, tracheostomy features, and laryngeal findings were collected. Videolaryngostroboscopy findings were analyzed by two senior laryngologists in a blind manner. Results: Forty-three patients completed the evaluations. The intubation duration was <14 days in 22 patients (group 1) and >14 days in 21 patients (group 2). The following abnormalities were found on an average post-intubation time of 51.6 days: posterior glottic stenosis (N=14), posterior commissure hypertrophy (N=19) or laryngeal diffuse edema (N=10), granuloma (N=8), laryngeal necrosis (N=2), vocal fold atrophy (N=2), subglottic stenosis (N=1) and glottic flange (N=1). Sixteen patients required surgical treatment (N=17 procedures). The number of intubation days was significantly higher in patients with posterior glottic stenosis (26.1 ± 9.4) compared with those presenting posterior commissure hypertrophy (11.5 ± 2.9) or granuloma (15.1 ± 5.8; p<0.001). Fourteen patients required surgical management. Conclusion: Prolonged intubation used in severe COVID-19 patients is associated with significant laryngeal disorders. Patients with a history of >2-week intubation have a higher risk of posterior glottic stenosis.

Malnutrition and swallowing disorders are common in Duchenne muscular dystrophy (DMD) patients. We assessed, in adult DMD with HMV (home mechanical ventilation) and cough assist device, its prevalence and the relationships with respiratory muscle strength and long-term respiratory prognosis. We reviewed the patients (n=117, age 18 to 39 years (median 24)), followed in a reference center, from 2006 to 2015, to obtain clinical baseline, nutritional status, vital capacity (VC), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP). Median body mass index was low (15.6). Prevalence of malnutrition, swallowing disorders and gastrostomy were respectively 62, 34 and 11%. BMI and serum albumin level were significantly associated with MIP, MEP and VC. The 1/5-years cumulative incidences of respiratory events (pulmonary sepsis and acute respiratory distress) were respectively 20.7/44.5%. Using univariate analysis, predictive factors for respiratory events were swallowing disorders (p=0.001), transthyretinemia (p=0.034), MIP (p=0.039) and MEP (p=0.03) but not BMI or albuminemia. Using multivariate analysis, only swallowing disorders remained significantly associated with respiratory events (OR=4.2, IC95% 1.31-12.2, p=0.01). If prevalence of malnutrition and swallowing disorders are high in adult DMD on HMV, and respiratory muscles strength associated with serum albumin level and BMI, respiratory prognosis is mainly related to swallowing disorders.