Communication and Swallowing changes after Covid-19

Since the emergence of Covid-19, both individuals with a diagnosis of the virus, and professionals treating them, have reported changes in individual’s speech, communication and swallowing.

Some of the reported changes include:

  • Changes to the sound of your voice. The voice may sound husky or croaky
  • Changes in thinking skills which is being described by many as ‘brain fog’. This appears to impact on how quickly you can think of information or concentrate on an activity.
  • A very small number of individuals may experience changes in their swallowing ability. This tends to be limited to those who have been admitted to hospital and have required assistance with their breathing or assistance with eating and drinking using a tube. It is important that this is managed effectively as swallowing difficulties can impact significantly on your physical health.
  • Changes in mental health particularly changes in mood and anxiety due to experiencing stress, worry, an altered daily routine and social isolation. This may impact on how you interact with people around you.

It is important to highlight that these changes vary significantly depending on how severely affected by the virus the individual has been.  The majority of individuals diagnosed with Covid-19 have not required hospitalisation or any specialised medical support.

For the small amount of individuals who have required hospitalisation or been admitted to intensive care, it is likely that they will experience longer term difficulties.  These individuals will be referred on to appropriate rehabilitation services following discharge from hospital.

Voice changes after COVID-19

This advice is compiled by a team of UK voice specialist Speech and Language Therapists from the UK Voice Clinical Excellence Network.

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.

Vocal cords sit in the voice box (also known as your larynx or Adam’s apple) at the top of the wind pipe.

In order to produce voice, we bring the vocal cords together 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.

When vocal cords become swollen and inflamed, 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.

  • 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 prolonged (more than 5 minutes) conversations by telephone, online chat, or video. Try to use text-based options instead.
  • You may notice that your voice fatigues more rapidly than normal. This is to be expected. Take a break from talking when you experience vocal fatigue; this gives the vocal cordstime to recover.
  • In addition to irritation from COVID-19, reflux can also irritate the throat. To minimise any possible reflux, avoid greasy foods and highly acidic foods and drinks such as; citrus fruits and juices, vinegar and pickles, tomatoes and tomato sauces, fizzy, caffeinated and alcoholic drinks etc. It can also be beneficial to take a liquid alginate (e.g. Gaviscon Advance) following meals and before bed.
  • Until the voice has returned to normal it is best to avoid “athletic” vocal activities such as shouting and singing.
  • If your voice has not completely returned to normal 6 – 8 weeks after starting with the COVID-19 virus symptoms, please contact the SLT Department in Cardiff and Vale UHB and/or your GP practice, as you may require voice therapy and a referral to ENT.
  • If you experience throat pain or difficulties swallowing food or drink which persists beyond six weeks after the onset of your COVID-19 symptoms, you should contact your GP practice, as you may require a referral to ENT.
  • If, during the course of your illness, you had to be treated in hospital with a breathing tube in your throat, you may have different or prolonged problems with your voice or throat. Please speak to your GP if you are concerned, as you may require a referral to ENT.
  • The experience of being very ill and possibly receiving treatment in hospital can be emotionally draining and, for some people, deeply upsetting. Our emotions and voice are closely linked, so it is worth being aware that emotional recovery and vocal recovery often progress hand-in-hand. Seek advice from your GP if you need more support.

Changes in Thinking ‘Brain Fog’ after Covid-19

It is thought this is caused by the body’s reaction to the virus as well as experiencing post viral fatigue. More general information can be found on the fatigue page.

Symptoms reported include:

  • Forgetting names and general word finding difficulties.
  • Finding it difficult to follow or concentrate on conversations and activities.
  • Planning, organising and making decisions is more effortful
  • Increased anxiety
  • Fatigue

Generally this will get better over time as your body generally recovers from the virus. However if this does not improve visit your GP to discuss options for further support you can access.

Strategies to support ‘Brain fog’

  • Take your time
  • Reduce distractions in your immediate environment to enable you to concentrate on what you are doing.
  • Use a calendar / reminders to support you to organise your time
  • Establish a routine and take regular breaks to support your fatigue

Swallowing Difficulties after Covid-19

In some circumstances after a diagnosis of Covid-19 people may experience difficulty swallowing, particularly if a person has spent time in hospital and on ITU. If someone has experienced severe difficulties breathing in hospital they may have had support to help them breathe (intubation or tracheostomy). If someone has been very unwell they may have also needed a tube to help feed them and may not have had anything to eat and drink for a while.
We use many different muscles when we chew and swallow food, and if we haven’t done this for a while, the muscles can become weaker and swallowing may be more effortful. Furthermore, after a long hospital stay people can experience general deconditioning, which can have a negative impact on their ability to swallow.

Speech and Language Therapists can assess a person’s swallowing and may offer methods to help make eating and drinking easier or safer. Advice for people experiencing swallowing difficulties (Dysphagia).

Changes to taste and smell

If you are experiencing changes to taste and smell following Covid-19 you can find further advice and information here.

Contact details

Adult Speech and Language Therapy Department
University Hospital of Wales
Heath Park Way
Cardiff
CF14 4XW

Telephone: 02920 743012

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