Changes to communication

Emerging evidence suggests a proportion of people with COVID-19 also experience changes to communication associated with neurological impairments.

You may experience:

• agitation and confusion
• impaired consciousness
• acute cerebrovascular events, for example stroke or encephalopathy, myopathy or neuropathy and hypoxia (lack of oxygen to the brain)
• delirium that may persist
• dysarthria – changes to the clarity of your speech
• dysphasia – changes to your ability to find words, form sentences, read or write
• dyspraxia – changes to how your brain sends messages to your mouth to form sounds or words
• dysphonia – changes to voice
• cognitive-communication disorders, for example changes to memory or planning.

To help, you can try:

• speaking slowly and with increased effort if your speech is not clear
• other methods if speaking is challenging, such as writing it down or gesturing
• to maintain a routine to reduce unexpected conversations if needed
• to look after your voice as much as possible, following the advice in these leaflets
• asking your household for help to remember information if needed
• limiting effortful communication if you are experiencing fatigue. This can be supported by routine, a familiar person who will know your wants and needs. Using alternative methods of communication where possible will support this.

This advice was originally adapted from a publication produced by the British Laryngological Association in May 2020 and a publication produced by the Royal College of Speech and Language Therapists in May 2020.

Changes to your voice

As a result of the COVID-19 virus you may experience some changes to the sound of your voice and to your comfort and effort levels when using it.

These changes are similar to changes you would expect to experience with a cold or flu but are expected to be more intense and last longer. We anticipate that these voice problems may take six to eight weeks to resolve gradually.

During the illness you are likely to have been coughing excessively for prolonged periods. This brings your vocal cords together forcefully and can leave them swollen and inflamed.

This makes them less able to vibrate freely, so the sound of your voice changes. Your voice may sound rough or weak and can be very effortful to produce.

Changes to your breathing as a result of Covid may impact the sound or function of your voice. Intubation can also contribute to changes in voice due to complications such as:

• oedema (swelling) and ulceration of the vocal cords
• vocal fold palsy
• acute and long-term impaired voice quality, for example weakness, hoarseness, vocal fatigue, reduced pitch and volume control.

To help, you can try:

• keeping well hydrated – drink one-and-a-half to two litres (four to five pints) of fluid each day, unless advised otherwise by your GP. Avoid caffeine and alcohol

• gentle steaming with hot water (nothing added to it). Breathe in and out gently through your nose or mouth. The steam should not be so hot that it brings on coughing

• avoiding persistent, deliberate throat clearing if you can and if you can’t prevent it, make it as gentle as possible. Taking small sips of cold water can help to supress the urge to cough

• chewing sugar free gum or sucking sugar free sweets or lozenges to promote saliva flow. This lubricates the throat and reduces the need for throat clearing. Avoid medicated lozenges and gargles as these can contain ingredients that may irritate the lining of the throat

• avoiding smoking or vaping

• talking for short periods at a time only. Stop and take a break if your voice feels tired

• aiming to use your normal voice. Don’t worry if all that comes out is a whisper or a croak, just avoid straining to force the voice to sound louder

• choosing not to whisper, as this does not save your voice but puts the voice box under strain

• avoiding attempting to talk over background noise such as music, the TV or car engine noise as this causes you to try and raise the volume of your voice which can be damaging

• speaking to your GP if you are experiencing reflux which can further irritate the throat

• avoiding using your voice for long periods, talking on the phone for too long or singing.

If your voice has not returned to normal after eight weeks, please speak to your GP or healthcare professional.

Go to leaflet…

• Long Covid
• Managing your breathing
• Managing your cough and clearing your chest
• Tiredness and fatigue
• Emotional impact
• Communication and changes to your voice
• Food and diet
• Quit smoking
• Getting active

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