Laryngeal lesions due to COVID-19 were mainly minor inflammatory symptoms with no specific findings, until the emergence of Omicron variants. After the emergence of Omicron variants, the number of patients complaining of severe sore throat, dysphagia, hoarseness, and dyspnea increased rapidly. In these cases, laryngoscopic findings are characterized by the formation of sticky, mottled white plaque in the laryngeal vestibule and erythema and edema extending below the subglottis and into the trachea. Steroids and antivirals should be considered in cases of airway stenosis and dehydration due to feeding difficulties, even if the disease is classified as “mild” according to the Japanese severity scale.

Laryngotracheal stenosis after COVID-19 infection is typically caused by invasive mechanical ventilation management, such as endotracheal intubation or tracheostomy, performed on the larynx and trachea while inflamed due to SARS-CoV-2 infection. Intubated patients infected with COVID-19 have a higher incidence of laryngotracheal stenosis than non-COVID-19 infected patients. Risk factors for developing laryngotracheal stenosis were found to be similar to those of non-COVID-19 infected and intubated patients. Most of the reported cases of bilateral vocal cord paralysis after COVID-19 infection appear to be due to posterior glottic stenosis rather than nerve paralysis, based on the course of the disease. Treatment of posterior glottic stenosis must emphasize preservation of the laryngeal function.

Tracheostomy is an aerosol-generating procedure that can be a source of infection to the surrounding personnel; therefore, tracheostomy for COVID-19 patients should be performed with appropriate care. There is no clear evidence that early tracheostomy within 10 days of intubation reduces the duration of ventilation or the mortality rate. There is no high risk of infection to healthcare providers due to tracheostomy if appropriate infection control measures are taken at the appropriate time. The nature of COVID-19 has changed from the early stages of the epidemic to the present owing to the introduction of vaccination and viral mutations. Up-to-date information should be reviewed before performing tracheostomy.

In the past few years, the prevalent emergence of the novel coronavirus disease (COVID-19) has resulted in significant repercussions on society, prompting the urgent implementation of infection control measures in general medical practices.

Medical professionals who provide dysphagia rehabilitation in close proximity can be at a high risk of transmitting the COVID-19 virus. Both non-swallowing (indirect) and swallowing (direct) exercises involve direct contact with a patient’s oral mucosa and secretions, and exposure to droplets/aerosols that can be generated by coughing and sneezing. Therefore, appropriate infection prevention measures, including using personal protective equipment (PPE), hand hygiene, and disinfection of environmental surfaces and equipment, should be implemented during dysphagia rehabilitation. During this period, medical professionals demonstrated unwavering commitment by proactively acquiring and applying specialized knowledge in infection control, alongside implementing creative enhancements in training, all aimed at delivering essential medical services while adhering to proper infection control measures.

In this review, I outline the implementation of swallowing rehabilitation during the COVID-19 outbreak, including trends in dysphagia in COVID-19 patients. Additionally, as a reminder, I detail medical countermeasures with a focus on addressing the novel coronavirus infection.

Unilateral vocal fold paralysis is a frequently encountered disorder of the larynx with a wide variety of underlying causes. Although spontaneous resolution of paralysis is observed in some cases, most patients will have permanent paralysis. This paralysis can result in hoarseness of voice, leading to a significant decline in the quality of life and interference with daily activities. However, many of these patients are not offered effective voice treatment options.

Our department believes that these patients are good candidates for voice improvement surgery, and we established an outpatient clinic specializing in voice disorders and laryngeal diseases in October 2016 to provide targeted and specialized treatment options. We subsequently tracked 29 patients who underwent laryngoplasty over a 6-year period from October 2016 to September 2022. All patients underwent arytenoid adduction and thyroplasty type 1 under local anesthesia. Twenty patients were followed for more than one year after surgery and were included in this study.

Although some patients did not show improvement in the maximum phonation time, all 20 showed improvement in the Voice Handicap Index after the surgery.

Varicella-zoster virus (VZV) reactivation is known to rarely cause inferior cranial nerve paralysis. We report our experience with nine cases. The symptoms of the nine patients included rash (n=4), pharyngeal pain (n=5), hoarseness (n=6), and all cases experienced dysphagia. Vagal (X) and glossopharyngeal (Ⅸ) nerve paralysis were observed in all cases, followed by facial (Ⅶ) nerve paralysis in six cases, vestibulocochlear (Ⅷ) nerve paralysis in seven cases, and accessory nerve paralysis in four cases. The diagnoses were confirmed by a serological analysis, cerebrospinal fluid analysis, or based on clinical findings. All patients were treated with a combination of acyclovir and intravenous steroids, and most achieved complete relief from laryngeal paralysis after varying periods of time.

In consideration of our nine cases, VZV reactivation should be kept in mind when we encounter laryngeal paralysis with rash and facial nerve paralysis, and physicians should consider that these symptoms are not always found simultaneously. Furthermore, patients with pharyngeal pain and dysphagia, which are other characteristics of VZV reactivation, require further examination to facilitate the early treatment of laryngeal paralysis caused by VZV reactivation.

Background: Partial inner laryngeal muscle palsy can cause unilateral vocal fold paralysis (UVFP). Clinically, adductor branch paralysis of the recurrent laryngeal nerve (AdBP) is of greater concern than posterior cricoarytenoid muscle (PCA) paralysis, as the former condition can lead to voice impairment, and some patients require surgery. We previously reported that arytenoid adduction (AA) combined with PCA dissection nearly normalized the voice. However, we encountered two patients with AdBP who underwent only type 1 thyroplasty.

Patients and Methods: Type 1 thyroplasty was performed in one case because abduction of the healthy side was inadequate, and we were concerned that dyspnea would develop after surgery. The other case did not consent to cutting of the PCA. Type 1 thyroplasty involved placement of a Gore-Tex^Ⓡ implant under local anesthesia.

Results: Both patients achieved a maximum phonation time of 9–10 s and a mean flow rate of 220–250 mL/s. Although these values were not within the normal range, both patients were satisfied with the results.

Conclusions: In the two cases described herein, the voice outcome was inferior to that which can be achieved by AA combined with PCA dissection. However, type 1 thyroplasty did improve the voice, and the patients were satisfied with the outcome; thus, this may be a useful surgical option for AdBP cases.

Primary tracheal carcinoma is a rare malignant tumor; among all malignant tumors, it is reported to occur account for 0.04% of malignancies in Japan and 0.1% in Europe and the United States, with squamous cell carcinoma, accounting for 45%, and adenoid cystic carcinoma, accounting for 41%. We report the case of a 79-year-old woman with papillary thyroid carcinoma, cT4aN0M0 (right recurrent), with laryngeal nerve and tracheal wall invasion, The patient underwent total thyroidectomy, right recurrent laryngeal nerve resection, and tracheal fenestration. On the 16th postoperative day, when attempting to remove the cannula, dyspnea developed, and the bilateral vocal cords were observed. The patient was diagnosed with paralysis. This did not improve despite follow-up. The patient was referred to our hospital for glottis surgery. Preoperative computed tomography (CT) images showed a mass protruding from the left wall of the trachea into the lumen, and pretracheal lymphadenopathy, suggesting intratracheal recurrence of papillary thyroid carcinoma and cervical lymph node metastasis. Therefore, glottis surgery was temporarily suspended and tumor resection (tumor resection including combined resection of the trachea and reconstruction of the tracheal wall using a DP flap) was planned and the operation was performed. A pathological examination revealed papillary carcinoma lymph node metastasis in the pretracheal lymph nodes, but the tumor tissue in the trachea was found to be low-grade mucoepidermoid. carcinoma, not papillary carcinoma. In the present case an intratracheal lesion after surgery for papillary thyroid carcinoma was identified as primary mucoepidermoid carcinoma of the trachea.

Posterior glottic stenosis (PGS) is commonly induced by tracheal intubation. The condition is treated by laryngeal microsurgery using scissors, lasers, and microdebriders under general anesthesia. We experienced the case of a woman in her 40s who developed PGS after tracheal intubation. She underwent tracheostomy for bilateral vocal fold paralysis. She was observed for one year, and her vocal fold movements did not improve. She was thereafter referred to our department to undergo the laterofixation of the vocal fold in order to treat her bilateral vocal fold paralysis. However, she was thus diagnosed with PGS. As a result of this new diagnosis, she underwent laryngeal microsurgery, in which the area of PGS was cut out with scissors. Unfortunately, her wound showed re-adhesion after surgery. We attempted to treat the patient using a green laser in an outpatient setting. This treatment proved to be successful, and the tracheal stoma was closed. Green lasers are generally used for photo-coagulation; however, their cutting ability is weak. In the present case, a green laser was successfully used for cutting. Green lasers may therefore be an effective option for the treatment of PGS after tracheal intubation.

Plasmacytoma is a neoplastic proliferation of plasma cells, a terminally differentiated type of B lymphocytes. Extramedullary plasmacytoma, which occurs outside the bone marrow, is a relatively rare disease. It is most commonly found in the head and neck regions, particularly in the sinonasal cavity. However, plasmacytoma rarely occurs in the larynx. In this report, we describe a case of extramedullary plasmacytoma in the supraglottis. A biopsy was performed to confirm the diagnosis. The patient with extramedullary plasmacytoma in the larynx was treated with radiation therapy and achieved reasonable local control without subsequent progression to multiple myeloma. Radiation therapy is the preferred treatment for localized extramedullary plasmacytoma. It is essential to select the appropriate treatment based on the site of occurrence, the patient’s medical history, and the degree of tumor progression.

In recent years, there have been cases of dysphonia in which symptoms were not seen in the examination room or in voice therapy settings. Speaking difficulty in these cases occurs only in specific situations, making a diagnosis and treatment difficult. Two types of questionnaires are administered to these patients. One is a questionnaire concerning the degree of fear and difficulty speaking that arises in daily life situations, while the other is a questionnaire that evaluates the level of attention, effort, and avoidance when speaking. The results obtained from these questionnaires are then shared with the patients, with treatments provided to alleviate the above issues. As a result of this treatment being performed on eight patients, the fear of speaking and dysphonia were improved in all cases according to the situational questionnaire. The degrees of attention, ingenuity, and avoidance decreased in all cases. This questionnaire approach to dysphonia that appears in specific situations was useful in all eight cases.