Because COVID-19 is still a relatively new virus, its effects on the body, both short and long-term, have yet to be understood. There are some we have heard about consistently throughout the pandemic, including loss of taste and smell, fatigue, brain fog, and cardiovascular risks. However, there are some effects that are yet to be appreciated. Vocal effects, in particular, are underrecognized.
This is largely because most people do not use the full capacity of their voice and so they may not even realize their voice is not working at 100%. Voice symptoms are also often ignored because we can push through voice fatigue and other vocal limitations as lay users.
This is not true for vocal performers.
Singers, professional speakers, voice actors and other vocal athletes are coming to attention more frequently for persistent voice symptoms after COVID. To most ears, their voices sound normal and even the vocalists admit that their voice is mostly normal. The voice symptoms are subtle and may hide behind other COVID recovery symptoms like fatigue and loss of vocal endurance. It is increasingly apparent, however, that there are serious effects from COVID that may hinder a vocalist’s performance and put them at higher risk of injury.
Does COVID affect the voice?
There are many ways COVID can affect the voice, even with mild or asymptomatic illness. During the acute illness, coughing can cause vocal injury and muscular tension. However, after resolution, there are still signs to look out for that warrant evaluation.
This patient had COVID 1 month earlier and was being seen to ensure she was safe to have surgery. Her larynx is generally swollen and she still had a mild cough a month later. Based on these findings, surgery was postponed. She was seen 1 month later with improvement in laryngitis and was cleared for surgery. The risk of injury when performing on swollen cords is high. However, this is increased further when there is ongoing swelling, so that the body cannot recover between shows. This makes the risk of injury during the second show even higher.
One of the most surprising symptoms in patients who had COVID and feel otherwise recovered has been vocal fatigue. Many chalk it up to deconditioning, as they have not been singing for some time. However, even as they try to resume vocal demand, they are finding their mix harder to achieve, a loss of vocal endurance, and difficulty with projection. These classic signs of vocal fold weakness are confirmed on examination and require specific rehabilitation strategies. Pushing through weakness may result in discomfort, muscular tension, or injury. Further performance with vocal weakness is usually suboptimal if not supported through voice rehab.
The singer in the video here had symptoms of voice fatigue 1 month after COVID, long after his other symptoms had resolved. His left vocal fold is weak and he will need rehabilitation to restore vocal function.
Muscular tension
Muscular tension around the larynx can arise from coughing, illness, or compensation for laryngitis or weakness. This produces many of the same symptoms as vocal cord paresis, including fatigue, loss of endurance and pitch issues. Vocal tension must therefore be differentiated from vocal cord paresis. This requires a complete vocal evaluation, not a rushed scope. A laryngologist evaluation is recommended to help vocal athletes get back on stage. Laryngeal manipulation can be extremely helpful to quick recovery.
The most dangerous thing a vocalist can do is resume work when they are dealing with any of the above, without having the support of a full voice team. Contact us to schedule an evaluation if you have had COVID and are resuming professional voice use.
