Rapid swallow improvement following Pharyngeal Electrical Stimulation in a COVID-19 patient with long-term severe neurogenic dysphagia: A case report

Abstract

Objective: Neurogenic dysphagia and other neurological manifestations are increasingly described in patients with SARS-CoV-2 (COVID-19). We report here a case of successful treatment of SARS-CoV-2-induced severe neurogenic dysphagia, using pharyngeal electrical stimulation (PES) in addition to speech and language therapy. Methods: A 62-year-old male patient with COVID-19 pneumonitis, prolonged intubation- and stroke-related severe neurogenic dysphagia, confirmed by instrumental assessment and traditional swallowing therapies, was given novel PES treatment for 5 days. Results: Within 8 days of completing PES, a clear improvement in dysphagia dysfunction scores (increased Dysphagia Outcome and Severity Scale (DOSS), reduced Penetration-Aspiration Scale (PAS), increased Functional Independent and Assessment Measure (FIM+FAM), and increased Functional Oral Intake Scale (FOIS)) was evident, and further significant improvement occurred in the following 2 weeks. Forty-three days post-stimulation, the patient?s diet had recovered to normal fluids and solids. Using self-administered Swallowing Quality of Life (SWAL-QoL) questionnaires, the patient reported a highly noticeable reduction in dysphagia-associated burden, a greatly decreased risk of choking when eating or drinking, developing pneumonia, and a large increase in self-confidence (total score: 11 pre-PES to 55 directly post-PES). Conclusion: In a patient with COVID-19 presenting with stroke and intubation-related severe dysphagia, PES was safe and appeared to facilitate faster recovery.