Objective and subjective voice evaluation in Covid 19 patients and prognostic factors affecting the voice

Abstract

Coronavirus disease 2019 (COVID-19), a respiratory and systemic zoonosis form caused by a virus belonging to the Coronaviridae family. Although several studies have shown the otolaryngology symptoms are affected in COVID-19 patients, the number of studies regarding the COVID-19 effects on voice is limited. Our study aims to evaluate the effect of COVID-19 on voice objectively - subjectively and compare it with the control group. 50 hospitalized patients with laboratory-confirmed COVID-19 and 50 healthy individuals were included in the study as study and control group, respectively. All subjects were trained to vocalize a continuous/a/ vocal pattern at speech sound intensity for Maximum Phonation Time. Voice samples were recorded using a Sony (ICD-PX470) audio recorder and analyzed by the Praat program. Dysphonia grades were ranked on 4-point scales (grade: 0=none; 1= mild; 2= moderate; 3=severe). It is seen from the results that, there were significant differences between the male and female participants in acoustic parameters of fundamental frequency (F0) (p<0.001), shimmer and mean harmonic to noise ratio (HNR) (p=0.011). There was also a significant difference in F0 values of infected and healthy participants (p=0.008). However, there was no significant interaction between gender and health status in any acoustic parameters (p>0.05). The degree of thoracic computed tomography (CT) involvement had no significant effect on parameters (p>0.05), while there was a weak positive relationship between the duration of hospitalization and F0 (rs=0.397, p=0.004). Dysphonia was positively associated with health status (rs=0. 682, p<0.001), and female infected participants reported more frequent dysphonia than males. In our study, we examined the effect of COVID-19 on voice both objectively and subjectively and evaluated the relationship between CT involvement and duration of hospitalization, which made our study more reliable. Future studies with larger and more specific patient groups to investigate the relationship between COVID-19 and dysphonia will shed a light on the subject.