Patient reported voice handicap and auditory-perceptual voice assessment outcomes in patients with COVID-19

Abstract

Purpose

The purpose of this study is to compare patient-reported voice handicap and auditory-perceptual measures of voice between healthy individuals and COVID-19 patients, as well as to investigate the effect of clinical factors on voice quality.

Methods

COVID-19 patients (n = 138) and 90 healthy controls were included in the study. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was used to grade voice samples based on overall severity, roughness, breathiness, strain, pitch, and loudness. The Voice Handicap Index-10 was completed by all participants (VHI-10). Physical (pVHI), emotional (eVHI) and functional (fVHI) subscores were calculated. Clinical data were collected (disease stage, CT grade, neutrophil/lymphocyte ratio, CRP, and symptoms).

Results

A statistically significant difference between patient and control groups in VHI-10 and CAPE-V scores was detected (p < 0.001). Except eVHI, total score and all subscale scores were higher in patients with COVID-19 as the pVHI was the most affected (η² = 0.324) subscale. All scores of CAPE-V were significantly worse in patients with COVID-19 as highest impact of COVID-19 was on breathiness (η² = 0.518). Pre-existing pulmonary comorbidity_, dyspnoea and N/L was significantly associated with the VHI-10 overall score (β_pc = 4.27, β_dyspnoea = 5.69 and β_nl = 0.25). The overall severity of CAPE-V was significantly dependent on dyspnoea and pulmonary comorbidity (β_dyspnoea = 11.25, β_pc = 10.12). VHI ≥4 and CAPE-V overall severity ≥11 were good indicators of COVID-19 related dysphonia.

Conclusions

COVID-19 causes patient-reported voice handicap and deteriorates auditory-perceptual measures of voice. COVID-19 related voice impairment was mainly associated with the decreased respiratory capacity.

Keywords:

• COVID-19
• dysphonia
• auditory-perceptual assesment
• voice handicap index

Acknowledgements

The authors express their gratitude to all participants of this study or their kind acceptance in this challenging times. The authors also thank to staff of İnfectious Disease Department for their assistance during data collection. The authors thank to Dr. Özlem Yaşar(PhD, Speech Language Therapist for her support and assistance in CAPE-V process and Dr. Naci Murat (PhD, Statistics) for his statistical review.

Disclosure statement

The authors declare no potential conflicts of interest with respect to this manuscript.

Previous Presentation

This study was presented as an e-poster at the 13th Congress of the European Laryngological Society (28 May 2021).

Data availability statement

The data that support the findings of this study are openly available in Mendeley Data Storage as; Tahir, Emel (2021), “covid vhi cape dataset”, Mendeley Data, v1. http://dx.doi.org/10.17632/r4z2k2kwkz.1. The work was conducted at Ondokuz Mayıs University School of Medicine Department of Infectious Disease and Clinical Microbiology and Department of Otolaryngology.

Additional information

Funding

The authors received no financial support for this research.

Notes on contributors

Emel Tahir

Emel Tahir, M.D MSc is an assistant professor of Otolaryngology. She was engaged Otology/Neurotology, Head & Neck Surgery and Laryngology & Phoniatrics certificate programs of Turkish Board of ORL-HNS. She also holds a MSc degree in Audiology. She is also a fellow of European Board of Otolaryngology-Hed and Neck Surgey.

Esra Kavaz

Esra Kavaz, M.D is an assistant professor of Otolaryngology. She is a fellow of Turkish Board of Otolaryngology-Head and Neck Surgey. She was engaged in Head & Neck Surgery and Otology/Neurotology certificate program of Turkish Board of ORL-HNS. She is focused on otology/neurotology and head and neck surgery.

Senem Çengel Kurnaz

Senem Çengel Kurnaz, M.D Associate Professor of Otolaryngology. Her main interest areas are head & neck surgery, thyroid surgery.

Fatih Temoçin

Fatih Temoçin, M.D Associate Professor of Infectious Diseases and Clinical Microbiology and faculty member.

Aynur Atilla

Aynur Atilla, M.D Associate Professor of Infectious Diseases and Clinical Microbiology and faculty member.