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COVID-19 has had an impact globally with millions infected, high mortality, significant economic ramifications, travel restrictions, national lockdowns, overloaded healthcare systems, effects on healthcare workers’ health and well-being, and large amounts of funding diverted into rapid vaccine development and implementation. Patients with COVID-19, especially those who become severely ill, have frequently developed dysphagia and dysphonia. Health professionals working in the field have needed to learn about this new disease while managing these patients with enhanced personal protective equipment. Emerging research suggests differences in the clinical symptoms and journey to recovery for patients with COVID-19 in comparison to other intensive care populations. New insights from outpatient clinics also suggest distinct presentations of dysphagia and dysphonia in people after COVID-19 who were not hospitalized or severely ill. This international expert panel provides commentary on the impact of the pandemic on speech pathologists and our current understanding of dysphagia and dysphonia in patients with COVID-19, from acute illness to long-term recovery. This narrative review provides a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis. We conclude with our international expert opinion on what we have learnt and where we need to go next as this pandemic continues across the globe.

Objectives: This study aims to (i) investigate post-extubation dysphagia and dysphonia amongst adults intubated with SARS-COV-2 (COVID-19) and referred to speech and language therapy (SLT) in acute hospitals across the Republic of Ireland (ROI) between March and June 2020; (ii) identify variables predictive of post-extubation oral intake status and dysphonia and (iii) establish SLT rehabilitation needs and services provided to this cohort. Design: A multi-site prospective observational cohort study Participants: 100 adults with confirmed COVID-19 who were intubated across eleven acute hospital sites in ROI and who were referred to SLT services between March and June 2020 inclusive. Main Outcome Measures: Oral intake status, level of diet modification and perceptual voice quality. Results: Based on initial SLT assessment, 90% required altered oral intake and 59% required tube feeding with 36% unable for oral intake. Age (OR 1.064; 95% CI 1.018-1.112), proning (OR 3.671; 95% CI 1.128-11.943), and pre-existing respiratory disease (OR 5.863; 95% CI 1.521-11.599) were predictors of oral intake status post-extubation. Two-thirds (66%) presented with dysphonia post-extubation. Intubation injury (OR 10.471; 95% CI 1.060-103.466) and pre-existing respiratory disease (OR 24.196; 95% CI 1.609-363.78) were predictors of post-extubation voice quality. Thirty-seven percent required dysphagia rehabilitation post-extubation whereas 20% needed voice rehabilitation. Dysphagia and dysphonia persisted in 27% and 37% cases respectively at hospital discharge. Discussion: Post-extubation dysphagia and dysphonia were prevalent amongst adults with COVID-19 across the ROI. Predictors included iatrogenic factors and underlying respiratory disease. Prompt evaluation and intervention is needed to minimise complications and inform rehabilitation planning.

No abstract

Parkinson's disease voice tremor is likely to be related to oscillatory movement in structures across the vocal tract rather than just the vocal folds. To progress clinical practice, more refined tools for the visual rating of tremor would be beneficial. How far voice tremor represents a functionally significant factor for speakers would also add to the literature.

Speech and voice changes are a central feature of the symptom complex of people with Parkinson's disease (pwPD). Speaking is a social activity involving the pwPD, family, and the wider communicative context. Sensory-motor, cognitive-linguistic, and affective changes in Parkinson's disease (PD) combine to alter communication, impacting on psychosocial quality-of-life, leading to risks of social withdrawal and increased depression and anxiety. The underlying pathophysiology of speech, voice, and communication difficulties in pwPD is multi-factorial and complex. Sensory-motor changes in the respiratory, phonatory, and articulatory subsystems, underscaling of effort, and central processing problems are further affected by broader cognitive-linguistic difficulties, and non-speech motor deficits. Many studies show that, when pwPD are asked to rate their own voice and how it functions in everyday situations, they show increased voice-related disability and negative impact relative to healthy controls. Voice treatment is integral to improving communication in pwPD. Studies show positive benefits from the perspective of pwPD and carers. Treatment approaches vary from one-to-one to group interventions, a singular focus on increasing loudness to more general voice exercises, and choral singing. The nature and underlying pathophysiology of speech, voice, and communication changes in pwPD are reviewed before exploring the effects of voice treatment programs and pwPD and carer perceptions of their effect. Larger scale, better powered, controlled trials of intervention for voice and speech that measure clinically and socially relevant outcomes are finally underway. Future research should also focus on issues of treatment compliance, practicality (for service delivery and use), and long-term follow-up outcomes. The role of carers in longer-term maintenance represents a further important area of exploration.

Acoustic analysis enhances understanding of PD voice tremor characteristics, its pathophysiology, and its relationship with voice disability and disease symptomatology.

A sustained phonatory vowel task with fibreoptic nasolaryngoscopic examination of pharyngeal and laryngeal musculature, supplemented by acoustic measures, is currently recommended for clinical identification, quantification and characterization of voice tremor.