Features of Mild-to-Moderate COVID-19 Patients With Dysphonia

doi:10.1016/j.jvoice.2020.05.012

. 2022 Mar;36(2):249-255.

doi: 10.1016/j.jvoice.2020.05.012. Epub 2020 Jun 4.

Features of Mild-to-Moderate COVID-19 Patients With Dysphonia

Jerome R Lechien¹, Carlos M Chiesa-Estomba², Pierre Cabaraux³, Quentin Mat⁴, Kathy Huet⁵, Bernard Harmegnies⁵, Mihaela Horoi⁶, Serge Daniel Le Bon⁶, Alexandra Rodriguez⁶, Didier Dequanter⁶, Stéphane Hans⁷, Lise Crevier-Buchman⁷, Baptiste Hochet⁷, Lea Distinguin⁷, Younes Chekkoury-Idrissi⁷, Marta Circiu⁷, Fahd El Afia⁷, Maria Rosaria Barillari⁸, Giovanni Cammaroto⁹, Nicolas Fakhry¹⁰, Justin Michel¹⁰, Thomas Radulesco¹⁰, Delphine Martiny¹¹, Philippe Lavigne¹², Lionel Jouffe¹³, Géraldine Descamps¹⁴, Fabrice Journe¹⁴, Eleonora M C Trecca¹⁵, Julien Hsieh¹⁶, Irene Lopez Delgado¹⁷, Christian Calvo-Henriquez¹⁸, Sebastien Vergez¹⁹, Mohamad Khalife²⁰, Gabriele Molteni²¹, Giuditta Mannelli²², Giovanna Cantarella²³, Manuel Tucciarone²⁴, Christel Souchay²⁵, Pierre Leich²⁵, Tareck Ayad¹², Sven Saussez²⁶

Affiliations

¹ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: Jerome.Lechien@umons.ac.be.
² COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.
³ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Neurology, CHU de Charleroi, Charleroi, Belgium.
⁴ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otolaryngology-Head & Neck Surgery, CHU de Charleroi, Charleroi, Belgium.
⁵ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Language Sciences, Faculty of Psychology, University of Mons, Belgium.
⁶ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
⁷ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
⁸ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Mental and Physical Health and Preventive Medicine, University of L. Vanvitelli, Naples, Italy.
⁹ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otolaryngology-Head & Neck Surgery, Morgagni Pierantoni Hospital, Forli, Italy.
¹⁰ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology- Head & Neck Surgery, APHM, Aix Marseille University, La Conception University Hospital, Marseille, France.
¹¹ Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium; Faculté de Médecine et Pharmacie, Université de Mons (UMONS), Mons, Belgium.
¹² COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada.
¹³ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Bayesia, Changé, France.
¹⁴ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
¹⁵ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otolaryngology- Head and Neck Surgery, University Hospital of Foggia, Foggia, Italy.
¹⁶ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Rhinology-Olfactology Unit, Department of Otorhinolaryngology, Head and Neck Surgery, Geneva University Hospitals (HUG), Geneva, Switzerland.
¹⁷ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Quironsalud Valencia, Spain.
¹⁸ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of otolaryngology-Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
¹⁹ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology-Head & Neck Surgery, CHU Rangueil-Larrey, Institut Universitaire du Cancer de Toulouse, Toulouse, France.
²⁰ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology-Head & Neck Surgery, EpiCURA Hospital, Baudour, Belgium.
²¹ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Division of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy.
²² COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Head and Neck Oncology and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
²³ Department of Otolaryngology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
²⁴ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otolaryngology-Head & Neck Surgery, Hospital Universitario de Jerez, Jerez, Spain.
²⁵ Department of Otolaryngology-Head & Neck Surgery, CHU Ambroise Paré, Mons, Belgium.
²⁶ Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Department of Otorhinolaryngology-Head & Neck Surgery, EpiCURA Hospital, Baudour, Belgium.

PMID: 32600873
PMCID: PMC7269945
DOI: 10.1016/j.jvoice.2020.05.012

Features of Mild-to-Moderate COVID-19 Patients With Dysphonia

Jerome R Lechien et al. J Voice. 2022 Mar.

. 2022 Mar;36(2):249-255.

doi: 10.1016/j.jvoice.2020.05.012. Epub 2020 Jun 4.

Authors

Affiliations

¹ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: Jerome.Lechien@umons.ac.be.
² COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.
³ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Neurology, CHU de Charleroi, Charleroi, Belgium.
⁴ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otolaryngology-Head & Neck Surgery, CHU de Charleroi, Charleroi, Belgium.
⁵ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Language Sciences, Faculty of Psychology, University of Mons, Belgium.
⁶ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
⁷ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
⁸ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Mental and Physical Health and Preventive Medicine, University of L. Vanvitelli, Naples, Italy.
⁹ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otolaryngology-Head & Neck Surgery, Morgagni Pierantoni Hospital, Forli, Italy.
¹⁰ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology- Head & Neck Surgery, APHM, Aix Marseille University, La Conception University Hospital, Marseille, France.
¹¹ Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium; Faculté de Médecine et Pharmacie, Université de Mons (UMONS), Mons, Belgium.
¹² COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada.
¹³ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Bayesia, Changé, France.
¹⁴ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
¹⁵ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otolaryngology- Head and Neck Surgery, University Hospital of Foggia, Foggia, Italy.
¹⁶ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Rhinology-Olfactology Unit, Department of Otorhinolaryngology, Head and Neck Surgery, Geneva University Hospitals (HUG), Geneva, Switzerland.
¹⁷ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Quironsalud Valencia, Spain.
¹⁸ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of otolaryngology-Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
¹⁹ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology-Head & Neck Surgery, CHU Rangueil-Larrey, Institut Universitaire du Cancer de Toulouse, Toulouse, France.
²⁰ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology-Head & Neck Surgery, EpiCURA Hospital, Baudour, Belgium.
²¹ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Division of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy.
²² COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Head and Neck Oncology and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
²³ Department of Otolaryngology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
²⁴ COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otolaryngology-Head & Neck Surgery, Hospital Universitario de Jerez, Jerez, Spain.
²⁵ Department of Otolaryngology-Head & Neck Surgery, CHU Ambroise Paré, Mons, Belgium.
²⁶ Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Department of Otorhinolaryngology-Head & Neck Surgery, EpiCURA Hospital, Baudour, Belgium.

PMID: 32600873
PMCID: PMC7269945
DOI: 10.1016/j.jvoice.2020.05.012

Abstract

Introduction: To explore the prevalence of dysphonia in European patients with mild-to-moderate COVID-19 and the clinical features of dysphonic patients.

Methods: The clinical and epidemiological data of 702 patients with mild-to-moderate COVID-19 were collected from 19 European Hospitals. The following data were extracted: age, sex, ethnicity, tobacco consumption, comorbidities, general, and otolaryngological symptoms. Dysphonia and otolaryngological symptoms were self-assessed through a 4-point scale. The prevalence of dysphonia, as part of the COVID-19 symptoms, was assessed. The outcomes were compared between dysphonic and nondysphonic patients. The association between dysphonia severity and outcomes was studied through Bayesian analysis.

Results: A total of 188 patients were dysphonic, accounting for 26.8% of cases. Females developed more frequently dysphonia than males (P = 0.022). The proportion of smokers was significantly higher in the dysphonic group (P = 0.042). The prevalence of the following symptoms was higher in dysphonic patients compared with nondysphonic patients: cough, chest pain, sticky sputum, arthralgia, diarrhea, headache, fatigue, nausea, and vomiting. The severity of dyspnea, dysphagia, ear pain, face pain, throat pain, and nasal obstruction was higher in dysphonic group compared with nondysphonic group. There were significant associations between the severity of dysphonia, dysphagia, and cough.

Conclusion: Dysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection. Dysphonic COVID-19 patients are more symptomatic than nondysphonic individuals. Future studies are needed to investigate the relevance of dysphonia in the COVID-19 clinical presentation.

Keywords: Clinical; Coronavirus; Covid-19; Dysphonia; ENT; Findings; Symptoms; Voice.

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Figures

**FIGURE 1**
The Proportions of general symptoms in dysphonic and nondysphonic patients. The ordinate axis consists of the prevalence of symptoms (percentages). Dysphonic Patients are represented in orange, nondysphonic are in green. Abbreviations: Abdo pain, Abdominal pain; LoA, loss of appetite; V, vomiting.

**FIGURE 2**
Angiotensin converting enzyme-2 (ACE2) expression in vocal folds. The immunohistochemistry analysis found a high expression of ACE2 in vocal fold tissues of healthy human (ongoing study - unpublished data). Ampliation: 1/100.

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[1] Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579:265–269. doi: 10.1038/s41586-020-2008-3. - DOI - PMC - PubMed

[2] Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579:265–269. doi: 10.1038/s41586-020-2008-3. - DOI - PMC - PubMed

[3] World Health Organization Data. https://covid19.who.intConsulted April 25, 8:00 P.M.

[4] World Health Organization Data. https://covid19.who.intConsulted April 25, 8:00 P.M.

[5] Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed

[6] Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed

[7] Shi Y, Yu X, Zhao H, et al. Host susceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan. Crit Care. 2020;24:108. doi: 10.1186/s13054-020-2833-7. - DOI - PMC - PubMed

[8] Shi Y, Yu X, Zhao H, et al. Host susceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan. Crit Care. 2020;24:108. doi: 10.1186/s13054-020-2833-7. - DOI - PMC - PubMed

[9] Lechien JR, Chiesa-Estomba CM, De Siati DR, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020 doi: 10.1007/s00405-020-05965-1. - DOI - PMC - PubMed

[10] Lechien JR, Chiesa-Estomba CM, De Siati DR, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020 doi: 10.1007/s00405-020-05965-1. - DOI - PMC - PubMed

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Features of Mild-to-Moderate COVID-19 Patients With Dysphonia

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Features of Mild-to-Moderate COVID-19 Patients With Dysphonia

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