Laryngitis and COVID-19 or ‘Covid Voice’

When you think about COVID-19, you may now think of it as a mild to severe upper respiratory infection that can cause several common symptoms like:

• Shortness of breath or difficulty breathing
• Extreme fatigue or tiredness
• Muscle aches and body aches
• Fever or chills
• Loss of taste or smell
• Coughing
• Sore throat

Occasionally, someone with COVID-19 might also experience hoarseness (dysphonia) and lose their voice, if only temporarily. Referred to as “Covid voice,” this raspy quality is actually acute laryngitis and carries its own set of symptoms.

While being hoarse may not seem like a big deal, there’s the small possibility of lingering damage to your vocal cords and larynx in much the same way that other COVID-19 symptoms can cause lingering damage to other parts of your body.

Laryngologist Paul Bryson, MD, explains the connection between laryngitis and COVID-19 and why these particular symptoms deserve your attention.

What causes a hoarse voice with COVID-19?

Over the last several years, people with COVID-19 have reported their voices going hoarse as the SARS-CoV-2 virus takes its course, making laryngitis and COVID-19 a combined growing concern.

A 2021 study of patients in Lombardy, a region of Northern Italy that experienced the first outbreak of COVID-19 in Europe, showed that hoarseness was a highly prevalent and long-lasting symptom that lingered for more than two weeks in nearly half of the patients studied.

A 2022 study found that hoarseness may be experienced by a quarter of people who have mild-to-moderate COVID-19 and that those who experience hoarseness were more symptomatic than those who were not.

Most recently, a 2023 systematic review of 21 studies comprising 13,948 patients found that 25% of people who had COVID-19 also experienced voice impairment, with about 70% of that population experiencing long-lasting voice-related symptoms.

So what’s the connection between laryngitis and COVID-19?

“Any upper respiratory tract infection is going to cause inflammation of the upper airway, and that includes the vocal cords,” states Dr. Bryson. “Laryngitis can occur with any upper respiratory virus.”

In general, the hoarseness you experience with COVID-19 is much the same as the hoarseness you’d experience with the flu or any other respiratory illness. COVID-19 makes laryngitis a particular concern because the SARS-CoV-2 virus itself causes inflammation. That means a lot of the secondary symptoms you’ll experience can worsen what’s going on with your voice.

“When an upper respiratory tract infection affects the lungs, like COVID-19, you’re going to be coughing even more,” explains Dr. Bryson. “You already have an inflamed throat and vocal cords from the infection and then, the secondary coughing that occurs can be quite violent and further irritating.”

Specifically, coughing can cause inflammation in your larynx. The larynx, also known as your voice box, is an organ in your throat that houses your vocal cords, two flaps of tissue that move to allow breathing and vibrate to help you speak.

That inflammation affects the flexibility of those vocal cords, making them swollen and stiff. That means they can’t vibrate as much. This can affect the pitch and depth of your voice, causing it to sound raspy or even reducing it to just a whisper.

Additional COVID-19 factors

But coughing isn’t the only COVID-19 symptom that can affect your vocal cords and, consequently, your voice.

“For patients who get COVID-19 and have a more severe case, one of the treatments is dexamethasone, which is a steroid,” says Dr. Bryson.

Those who receive steroids, particularly those with other immune issues, can also develop thrush, a fungal infection that develops in the mouth and throat. This infection can reside on your vocal cords, causing additional irritation and a fungal laryngitis.

The vagus nerve and post-viral neurogenic coughing

Additionally, Dr. Bryson points out that any nerve in the upper airway can be affected by inflammation caused by a virus. He notes a study that explored how COVID-19 might cause damage to the vagus nerve, which, in turn, can cause long-lasting damage to the vocal cords.

Post-viral coughing can be a significant issue for some people and cause prolonged hoarseness, while coughing is still an issue for some recovering from COVID-19.

Can you prevent laryngitis when you have COVID-19?

There’s not much you can do to prevent the development of laryngitis or other throat and vocal cord problems when you have COVID-19. Dr. Bryson says that, for many, it may not even be a very prevalent issue during the course of your illness.

“In a lot of cases, the hoarse voice isn’t evident or a big part of their illness,” he clarifies. “Partly that’s because the main concern is focused on other symptoms. And it’s also something that may not start coming up until they start to heal from their other symptoms and find themselves hoarse if that is the one symptom that persists.”

How do you treat laryngitis when you have COVID-19?

While you might not be able to do much to prevent laryngitis, Dr. Bryson says there are things you can do to treat it if you’re sick.

• Stay hydrated. “Dry cough receptors promote more coughing, which causes more irritation,” he reports. “So, staying well-hydrated can keep those cough receptors from being activated.”
• Use cough drops and other over-the-counter cough suppressants. Yes, these can help you out with COVID-19 just like other respiratory diseases. “I recommend these with any kind of upper respiratory issue,” says Dr. Bryson, “because cough drops, especially menthol ones, numb the nerves of the cough receptors and make your trigger a little less sensitive.”
• Speak less, speak softer. “It’s a more extreme approach, but avoid speaking and avoid speaking loudly,” he recommends. “The more you use your voice, especially often and at a loud volume, the more irritation that can occur.”
• Eat a healthy diet. “A healthy diet is important across the board,” Dr. Bryson emphasizes, “but it also minimizes those acid reflux issues that can worsen the situation in your throat.”

Other medical treatments

The combination of laryngitis and COVID-19 is like a one-two punch to your upper respiratory system. But with the right treatment and the right preventive measures during your illness, this duo can be dealt with.

And as issues linger during your recovery, it’s important to keep track of what’s happening and seek other medical attention as needed. If your laryngitis lasts for longer than two weeks or remains after you’re no longer positive for COVID-19, talk to your healthcare provider about additional treatment options.

Post-COVID-19 asthma

Developing asthma after a case of COVID-19 has been an issue for some people, and Dr. Bryson suggests keeping an eye on your symptoms for something like this. Besides the issue of your overall health, untreated respiratory issues only promote more coughing and potential damage to your vocal cords.

“If you’re feeling any symptoms of shortness of breath or other potential asthma symptoms post-illness, you need to be evaluated,” he stresses. “If needed, you could be given an inhaler, which minimizes coughing and lessens the strain on your vocal cords as they heal.”

Consider ENT specialists

It may take a while for your voice to improve, but it should eventually get better. If it doesn’t, Dr. Bryson advises seeking treatment from an otolaryngologist or ear, nose and throat (ENT) specialist.

“An ENT specialist has an expertise and interest in the vocal cords, including additional treatments that may help speed up recovery if you’ve been dealing with laryngitis,” he adds.

One such treatment is an injection into the nerves of the vocal cords. “Medicines like gabapentin or amitriptyline numb the nerves of the cough receptors,” he explains. “Just by treating those nerves a bit, you can minimize the coughing and hoarseness.”