25 Percent of All Exposed to COVID-19 Will Develop Dysphonia And 70 Percent of Them Will Have Persistent Voice Issues

Medical News: COVID-19 has proven to be a multifaceted virus, with its impacts stretching far beyond the respiratory system. Among the lesser-discussed but increasingly recognized complications is dysphonia, or voice impairment. Recent research reveals that a staggering 25% of individuals who contract COVID-19 develop dysphonia during the acute phase of infection. Alarmingly, approximately 70% of these individuals continue to suffer from persistent voice-related issues even after recovery. This Medical News report delves into the findings from key studies conducted by researchers from Botucatu Medical School, UNESP in São Paulo, Brazil, and Kaohsiung Chang Gung Memorial Hospital in Taiwan, shedding light on the prevalence, causes, and implications of COVID-related dysphonia.


25 Percent of All Exposed to COVID-19 Will Develop Dysphonia And 70 Percent of Them Will Have
Persistent Voice Issues

What is Dysphonia?
Dysphonia is a condition characterized by difficulty in voice production, which may manifest as hoarseness, breathiness, or vocal fatigue. For many, the condition significantly hampers communication, leading to reduced quality of life. While vocal issues may not seem as urgent as respiratory distress, they carry profound implications for mental well-being and social interaction.
 
Key Findings of the Studies
Two major studies provide critical insights into the prevalence and persistence of dysphonia in COVID-19 patients.
 
The first study, conducted by Botucatu Medical School, reviewed 41 studies involving 5,139 patients. The findings highlighted that the prevalence of dysphonia among COVID-19 patients ranged from 0.39% to 79%, with vocal symptoms such as hoarseness, cough, sore throat, and aphonia being the most common.
 
Videolaryngoscopic examinations revealed various complications, including vocal fold paralysis, erythema, and muscle tension dysphonia.
 
The second study, from Kaohsiung Chang Gung Memorial Hospital, analyzed 13,948 patients across 21 studies. It concluded that 25.1% of COVID-19 patients experienced dysphonia during the acute infection phase. Among those, approximately 70% continued to face voice-related issues for months or even years post-recovery, a condition now widely recognized as long-COVID dysphonia. This article aims to make these findings accessible to a broader audience while emphasizing their clinical implications.
 
Why Does COVID-19 Cause Dysphonia?
COVID-19 primarily affects the respiratory system, but its impact on the aerodigestive tract explains its influence on vocal health. The virus gains entry into cells using the ACE2 receptor, which is highly expressed in the vocal cords and surrounding tissues. The resulting inflammation and immune response often lead to damage in these areas.
 
Key videolaryngoscopic findings from the studies include:
 
-Vocal fold paralysis (unilateral and bilateral)
-Erythema (redness due to inflammation)
-Benign lesions and granulomas
-Muscle tension dysphonia
-Glottal closure issues
 
In severe cases, patients required invasive procedures such as intubation or tracheostomy, which further exacerbated vocal impairments. However, even those without such interventions reported significant vocal changes, suggesting that COVID-19’s effects on the voice extend beyond mechanical damage.
 
Long-COVID Dysphonia: A Persistent Challenge
While many COVID-19 symptoms resolve within weeks, dysphonia often lingers. Approximately 17.1% of patients experience voice issues after recovery, with 20.1% suffering from long-COVID dysphonia. These persistent symptoms include hoarseness, vocal fatigue, and difficulties with pitch and volume control.
 
Factors contributing to long-COVID dysphonia include:
 
-Chronic inflammation of the vocal cords
-Scar tissue formation
-Muscular tension from prolonged coughing or vocal strain
-Psychological stress and anxiety, which can exacerbate muscle tension dysphonia
 
Gender Differences in Dysphonia
Interestingly, the studies found gender disparities in dysphonia prevalence. Women were more likely to experience voice impairment than men during acute infection. Researchers speculate that hormonal differences and variations in immune response may play a role. For example, estrogen has been linked to increased immune activity, which could explain why women might have a heightened inflammatory response in the vocal cords.
 
Implications for Treatment and Management
Given the high prevalence and long-term nature of COVID-related dysphonia, early diagnosis and intervention are crucial. Recommendations for managing dysphonia include:
 
-Videolaryngoscopic Examination: This helps identify structural issues such as paralysis or lesions.
 
-Speech Therapy: Tailored exercises can improve vocal strength and reduce strain.
 
-Pharmacological Interventions: Anti-inflammatory medications and corticosteroids may be prescribed to reduce swelling.
 
-Surgical Options: In cases of severe structural damage, surgical interventions may be necessary.
 
-Lifestyle Adjustments: Avoiding irritants such as smoking and adopting a diet that minimizes acid reflux can help preserve vocal health.
 
Broader Implications
Dysphonia has far-reaching consequences beyond physical discomfort. For many, the condition leads to social isolation, reduced self-confidence, and even career disruptions, particularly for those in professions reliant on their voice, such as teachers, singers, and public speakers.
 
Conclusion: A Call to Action
COVID-related dysphonia is not merely a temporary inconvenience but a significant health issue with long-term implications. Approximately 25% of individuals exposed to COVID-19 will develop dysphonia during the acute infection phase, and 70% of these will face persistent voice challenges. These findings underscore the need for greater awareness among healthcare providers and the general public. Early intervention, comprehensive evaluation, and tailored treatment plans can mitigate the long-term impact of dysphonia and improve the quality of life for affected individuals.
 
The study findings were published in the peer-reviewed Journal of Voice
https://www.sciencedirect.com/science/article/abs/pii/S0892199724004193
 
and American Journal of Otolaryngology.
https://www.sciencedirect.com/science/article/pii/S0196070923001643
 
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https://www.thailandmedical.news/articles/coronavirus
 
https://www.thailandmedical.news/articles/long-covid