Increased Incidence of Tapia’s Syndrome Cases Since the COVID-19 Pandemic

Dear editor,

We want to draw your attention and that of the readers to a gradual increase in published cases of Tapia’s Syndrome (TS) since the arrival of COVID-19. TS is a rare clinical entity characterized by concomitant lesion of the hypoglossal nerve and the recurrent laryngeal branch of the 10th nerve.^1,2 Compression or stretching of these nerves in their extracranial course after orotracheal intubation is the most common mechanism.^3,4 A few exceptional cases of central TS have also been reported following brainstem lesions. ⁴ We recently managed a 50-year-old patient presenting dysphonia due to left vocal fold paralysis, swallowing disorders and left tongue deviation. He recently developed COVID-19 complicated by acute respiratory distress syndrome and required respiratory assistance for 19 days. Prone position ventilation was regularly performed. After extubation and ENT assessment, he benefited from 10 days of oral steroids (Methylprednisolone 1 mg/kg/day) and vocal and swallowing rehabilitation. Three months after extubation, he did not recover.

Prolonged orotracheal intubation, cuff overinflation, neck hyperextension and prolonged compression from throat packs have been reported as the main risk factors for developing this syndrome.^4,5 More recently, it has been suggested that the prone position used in severe forms of COVID-19 may be a contributing factor via lateral flexion of the head, which would induce prolonged stretching of the nerves. ³ As in our case, the resurgence of this syndrome with COVID-19 would come from an increase in prolonged intubations and prone position. Since TS can be associated with significant comorbidities, preventive measures such as keeping the head of the intubated patient in the most neutral position possible, checking the correct pressure of the cuff and performing a tracheotomy after a maximum of 10 days of orotracheal intubation should be considered. When TS is diagnosed, vocal and swallowing rehabilitation should be started as soon as possible. ⁴ The use of corticosteroids is still controversial.^4,6