Prevalence of Dysphonia in Non hospitalized Patients with COVID-19 in Lombardy, the Italian Epicenter of the Pandemic

Abstract

Introduction Dysphonia has been described in patients affected by coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the prevalence of dysphonia, and its severity and extent, of voice fatigue and of dysphagia in nonhospitalized patients affected by COVID-19 in Lombardy, the Italian region most hit by the first explosive outbreak of COVID-19 in Europe. Methods Demographic and clinical data of 160 consecutive patients, with COVID-19 diagnosis confirmed by nasal swabs processed by reverse transcription polymerase chain reaction, were gathered by means of telephone interviews performed by physicians in charge of daily follow-up. General and specific symptoms concerning voice and swallowing impairment were investigated. Dysphonia grade and duration were graded on 4-point scales, while voice fatigue was graded on a 5-point scale. Results Dysphonia was reported by 70 (43.7%) patients and was positively associated with voice fatigue (P<0.001), cough (P=0.005), rhinitis (P=0.01), and dyspnea (P=0.06); it was mild/moderate in 69 patients, but its duration was > 2 weeks in 33/70 (47.1%) patients and >1 month in 11/70 (15.7%). Grade and duration of dysphonia were positively associated with cough and rhinitis (all P-values <0.01). Voice fatigue was reported by 43/160 patients (26.8%) and its severity was correlated with dysphonia (P<0.0001), cough (P=0.02), rhinitis (P=0.02), dyspnea (P<0.001), and loss of appetite (P=0.01). Dysphagia was encountered in 27/160 patients (16.9%) and was associated with dysgeusia, cough, arthralgia, myalgia and loss of appetite but not with dysphonia. Conclusions Dysphonia was a highly prevalent and long-lasting symptom in this series; it has been underestimated to date. Further studies might shed light on the pathophysiology of voice disorders in COVID-19 patients.

Prevalence of dysphonia due to COVID-19 at Salahaddin General Hospital, Tikrit City, Iraq

“…Despite the dysphonic patients in the current study were mostly with mild form (47.6%), the majority were persistent for more than one month (11/18 patients). This interesting observation was consistent with Cantarella et al study [ 6 ]. The prolonged duration of dysphonia is an indication that COVID-19 disease causes a severe and prolonged abnormality of the voice.…”

“…The mean age in the present study in the dysphonic patients (64.62 years) was higher than the non-dysphonic (59.99 years), but there was no statistically significant difference between the 2 groups. A similar finding have reported by Cantarella et al despite the mean age of their patients was lower than our patients [ 6 ]. This observation could explain that the dysphonia due to COVID-19 disease affects all age groups in nearly equal proportions.…”

“…Although our study was showing a slight predominance of females, there was no significant difference between males and females (P-value = 0.527) between the dysphonic and non-dysphonic groups. A similar finding has been reported by Cantarella et al's study [ 6 ]. However, the study was inconsistent with Lechien et al study, which have reported more females with dysphonia than males (P-value = 0.022) [ 5 ].…”

“…It is well known that the viral infections can cause dysphonia with an incidence of less than 20% due to common viral infection [ 12 ]. However, in a two recent studies from Europe have been reported a high prevalence of dysphonia 26.8% by Lechien et al and 43.7% by Cantarella et al in mild and moderate forms of COVID-19 disease [ 5 , 6 ]. We reported a lower prevalence of 22.3% in hospitalized patients than in the previous 2 studies.…”

“…A prior study by Li et al have reported that vocal folds were associated with a high expression of angiotensin-converting enzyme 2 (ACE2), which is a specific receptor of the COVID-19 virus [ 4 ]. Researchers from Europe have reported a high prevalence of dysphonia due to COVID-19 disease with a prevalence of 26.8% by Lechien et al and 43.7% by Cantarella et al [ 5 , 6 ]. However, scarce studies, mainly in form of case reports or low prevalence of dysphonia, were reported from other parts of the world [ [7] , [8] , [9] ].…”