What Is “COVID-19 Voice” and What Causes It?

Throughout the COVID-19 pandemic, the virus has continued to reveal additional symptoms and complications as it spreads across the globe. And one symptom now getting more attention is how it can affect your voice.

While the idea of the virus affecting your voice may seem a bit of a stretch, it happens as a result of other issues that the virus can cause. And while being hoarse may not seem like a big deal, there’s the possibility of lingering damage as with other COVID-19 symptoms.

Pulmonary and critical care doctor Joseph Khabbaza, MD, tells us what to know about this particular symptom and why it deserves your attention. 

What causes a hoarse voice with COVID-19?

Some COVID-19 patients report their voices going hoarse as the virus takes its course. But that symptom has its roots in other consequences of the COVID-19 virus.

“Any upper respiratory tract infection is going to cause inflammation of the upper airway,” says Dr. Khabbaza. “That includes the vocal cords. Laryngitis can occur with any of those viruses.” 

COVID-19, though, takes that one step further. “The virus itself causes inflammation,” he says, “but it’s a lot of the secondary symptoms that worsen what’s going on.”

“When an upper respiratory tract infection affects the lungs, like COVID-19, you’re going to be coughing even more,” he continues. “You already have an inflamed throat and vocal cords from the infection and then the secondary coughing that occurs can be quite violent and further irritating.” 

Specifically, coughing can cause inflammation in the larynx. The larynx, also known as the voice box, is an organ in your throat that houses the vocal cords, two flaps of tissue that move to allow breathing and vibrate to help you speak. 

That inflammation affects the flexibility of those vocal cords, making them swollen and stiff. That means they can’t vibrate as much. This can affect the pitch and depth of your voice, causing it to sound raspy or even reducing it to just a whisper. 

Additional COVID-19 factors

Coughing isn’t the only COVID-19 symptom, though, that can affect your vocal cords and, consequently, your voice. “For patients who get COVID-19 and have a more severe case, one of the treatments is dexamethasone, which is a steroid,” he notes. 

Steroids, he says, can lead to increased acid reflux which, in turn, causes a direct acid chemical irritation of your throat and vocal cords. 

Those who receive steroids, particularly those with other immune issues, can also develop thrush, a fungal infection that develops in the mouth and throat. The infection can reside on the vocal cords, causing additional irritation. 

The vagus nerve

Additionally, Dr. Khabbaza points out that any nerve in the upper airway can be affected by inflammation caused by a virus. He notes a study that explored how COVID-19 might cause damage to the vagus nerve which, in turn, can cause long-lasting damage to the vocal cords.  

“If the vagus nerve isn’t working well, the vocal cords may not work the way they are supposed to and may stay closed when they should open,” he says. “That can also cause additional sensations of breathlessness and coughing which perpetuates this cycle of irritation.”

Ventilators

In severe cases of COVID-19, you can be put on a ventilator which can cause issues with your vocal cords when you recover. “If you’re put on a ventilator, you already have to deal with the other symptoms plus having a plastic tube go through your vocal cords for up to several weeks in extreme cases. That can cause some lingering vocal cord issues for some time,” he says. 

Can you prevent a hoarse voice with COVID-19?

As with other illnesses, there’s not much you can do to prevent the development of “COVID-19 voice” or other throat and vocal cord problems. Dr. Khabbaza says that, for many, it may not even be a very prevalent issue during the course of your illness. 

“In a lot of cases, the hoarse voice isn’t evident or a big part of their illness,” he says. “Partly that’s because the main concern is focused on other symptoms. And it’s also something that may not start coming up until they start to heal from their other symptoms and find themselves hoarse if that is the one symptom that persists.”

How do you treat your COVID-19 hoarse voice?

While you might not be able to do much to prevent a hoarse COVID-19 voice, Dr. Khabbaza says there are things you can do to treat it if you’re sick. 

• Stay hydrated. “Dry cough receptors promote more coughing which causes more irritation,” Dr. Khabbaza says. “So staying well-hydrated can keep those cough receptors from being activated.”
• Cough drops. Yes, these can help you out with COVID-19 just like other respiratory diseases. “I recommend these with any kind of upper respiratory issue,” he says, “because cough drops, especially menthol ones, numb the nerves of the cough receptors and make your trigger a little less sensitive.” 
• Speak less, speak softer. “It’s a more extreme approach, but avoid speaking and avoid speaking loudly,” he suggests. “The more you use your voice, especially often and at a loud volume, the more irritation that can occur.”
• A healthy diet. “A healthy diet is important across the board,” Dr. Khabbaza says, “but it also minimizes those acid reflux issues that can worsen the situation in your throat.” 

Other medical treatments

As issues linger during your recovery, it’s important to keep track of what’s happening and seek other medical attention as need. 

Post-COVID-19 asthma

Developing asthma after a case of COVID-19 has been an issue for some patients and Dr. Khabbaza suggests keeping an eye on your symptoms for something like this. 

“If you’re feeling any symptoms of shortness of breath or other potential asthma symptoms post-illness, you need to be evaluated,” he says. Besides the issue of your overall health, he says, untreated respiratory issues only promote more coughing and potential damage to your vocal cords. 

“If needed, you could be given an inhaler which minimizes coughing and lessens the strain on your vocal cords as they heal,” he says. 

Consider ENT specialists

It may take a while for your voice to improve, Dr. Khabbaza says, but it should eventually get better. If it doesn’t, however, he says you could seek treatment from an ear, nose and throat (ENT) specialist.

“An ENT specialist has an expertise and interest in the vocal cords, including additional treatments that may help speed up recovery,” he says. 

One such treatment is an injection into the nerves of the vocal cords. “Medicines like gabapentin or amitriptyline numb the nerves of the cough receptors,” he says. “Just by treating those nerves a bit, you can minimize the coughing and hoarseness.”

Be sure to check with your healthcare provider before making any specialist appointments so you can make sure you’re up to date on all potential treatment options.