An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic

Abstract

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a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis.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.

Self-perceived dysphagia in non-invasively ventilated COVID-19 patients

“…Similarly, one study [ 12 ] involved COVID-19 patients with mild (71.5%) and moderate (28.4%) severity and showed that 24 (20.6%) out of 116 patients suffered from dysphagia. Another study [ 19 ] found that 3 (14%) of the small preliminary dataset of 21 non-hospitalized patients presented with self-reported dysphagia. The disparity between the results of these studies and ours could be largely explained by the differences in sample size.…”

“…Old age was usually linked to greater ICU admission rates and mortality from COVID-19, particularly among those with comorbidities [ 19 ]. In the current study, the average age of participants happened to be in the mid-30 s, probably because we included less severe, non-ICU patients.…”

“…Following up on these patients would be valuable to understand the fate and evolution of symptoms over time. Re-evaluation of patients should extend beyond recovery from COVID-19 acute illness because prolonged sequelae as well as relapsing–remitting symptom patterns are possible [ 19 ].…”

“…Dysphagia is a common complication in post-ICU patients in general [ 19 ]. High incidence of dysphagia in COVID-19 patients who were hospitalized, treated in the ICU, or mechanically ventilated has also been reported [e.g., 2 , 13 , 20 , 21 ].…”

Isolated Severe Dysphonia as a Presentation of Post-COVID-19 Syndrome

“…The studies concerning voice disorders in the course of COVID-19 disease were mainly based on subjective methods of examination [ 8 , 9 , 10 ]. The use of instrumental methods of assessment in diagnosing dysphonia in COVID-19 patients, namely, videolaryngoscopy, fluoroscopy, fibro-optic laryngoscopy, was reported only by a few researchers [ 11 , 12 , 13 , 14 ]. Instrumental data on dysphonia after COVID-19 are not plentiful and only emerging now because of restrictions in the use of endoscopy at the outset of the pandemic [ 14 ].…”