Covid: Voice problems

This advice is compiled by a team of UK voice specialist Speech and Language Therapists.
Source: British Laryngological Association

As a result of the COVID-19 virus you may experience some temporary changes to the sound of your voice, and to your comfort and effort levels when using it. These changes are similar to the changes you would expect to experience with a cold or 'flu, but are expected to be more intense and longer lasting. We anticipate that these voice problems may take 6 – 8 weeks to gradually resolve. The following advice will help your vocal recovery.

Why has your voice changed?

Vocal cords sit in the voice box (also known as your larynx or Adam’s apple) at the top of the wind pipe. Pictures 1 and 2 are photos of healthy vocal cords.

In order to produce voice, we bring the vocal cords together (see picture 2) and gently blow air through them from the lungs below, which causes their delicate membranes to vibrate. This vibration is the sound of the human voice.

When you have COVID-19 you are likely to experience excessive and prolonged attacks of coughing. Coughing brings the vocal folds forcefully together to allow strong expulsion of air, clearing any mucus from your lungs and throat. This level of coughing gives the vocal cords quite a battering; consequently, they can become swollen and inflamed.

Picture 3

Swollen and inflamed larynx   

Picture 4

Swollen larynx coated in thisck mucus                                                                    

When vocal cords become swollen and inflamed, as they are in pictures 3 and 4, they become stiff and less flexible. This means that they are unable to vibrate freely, so the sound of the voice changes, often becoming rougher and deeper-pitched or possibly no more than a whisper. It can feel uncomfortable and hard work to speak when your vocal cords are in this state.

What can you do to protect your vocal cords and help them to heal?

• Keep well hydrated. Drink 1½ – 2 litres (4 – 5 pints) of fluid that doesn’t contain caffeine or alcohol per day (unless advised otherwise by a doctor).
• Try gentle steaming with hot water (nothing added to the water). Breathe in and out gently through your nose or mouth. The steam should not be so hot that it brings on coughing.
• When the virus is at its peak, coughing is likely to be intense and unavoidable. However, once this stage of the illness passes, try to avoid persistent, deliberate throat clearing and, if you can’t prevent it, make it as gentle as possible. Taking small sips of cold water can help to supress the urge to cough.
• Chewing gum or sucking sweets can help promote saliva flow, which lubricates the throat and can help to reduce throat clearing. Avoid medicated lozenges and gargles, as these can contain ingredients that irritate the mucosal lining of the throat.
• You do not need to be on total voice rest, i.e. silent. Even in the early stages of the virus, when the voice is at its worst, using the vocal cords for a few short utterances every so often during the day keeps them mobilised, and this is a good thing.
• Always aim to use your normal voice. Don’t worry if all that comes out is a whisper or a croak; just avoid straining to force the voice to sound louder.
• Don’t deliberately choose to whisper; this does not “save” the voice; it puts the voice box under strain.

• Avoid smoking or vaping.
• Avoid attempting to talk over background noise such as music, television or car engine noise, as this causes you to try to raise the volume, which can be damaging.
• If your voice is no more than a whisper do not attempt telephone, online chat, or video conversations. Once the voice starts to improve, avoid prolo

   

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