Introduction: Due to the upper and lower respiratory involvement in coronavirus disease 2019 (COVID-19), the voice quality of these patients is expected to be impaired. In this study, we aimed to conduct an auditory-perceptual evaluation of the vocal characteristics of patients with different severities of COVID-19. Methods: One hundred two patients with mild, moderate, or severe COVID-19 as well as 30 healthy individuals were recruited to compare their respiratory/phonatory parameters. The Persian version of the CAPE-V and GRBAS scales, along with the maximum phonation time and s/z ratio values were used to evaluate the severity of respiratory/phonatory disorders during verbal tasks in the participants. Results: Significant differences were found between the subgroups of patients and their healthy counterparts in all respiratory/phonatory parameters (p ≤ 0.03) except the s/z ratio (p = 0.81). Conclusions: Based on auditory-perceptual assessments, patients with COVID-19 showed dysphonia. The severity of dysphonia was significantly different among patients with different severities of COVID-19. Smoking can also play a significant role in vocal dysfunction in COVID-19 patients.

1.
Joffily
L
,
Ungierowicz
A
,
David
AG
,
Melo
B
,
Brito
CL
,
Mello
L
, et al.
The close relationship between sudden loss of smell and COVID-19
.
Rev Bras Otorrinolaringol (Engl Ed)
.
2020
Sep - Oct
;
86
(
5
):
632
8
.
[PubMed]
1808-8686
2.
Yuki
K
,
Fujiogi
M
,
Koutsogiannaki
S
.
COVID-19 pathophysiology: A review
.
Clin Immunol
.
2020
Jun
;
215
:
108427
.
[PubMed]
1521-7035
3.
Shi
H
,
Han
X
,
Jiang
N
,
Cao
Y
,
Alwalid
O
,
Gu
J
, et al.
Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study
.
Lancet Infect Dis
.
2020
Apr
;
20
(
4
):
425
34
.
[PubMed]
1474-4457
4.
Zhang
J
,
Wang
M
,
Zhao
M
,
Guo
S
,
Xu
Y
,
Ye
J
, et al.
The clinical characteristics and prognosis factors of mild-moderate patients with COVID-19 in a mobile cabin hospital: A retrospective, single-center study
.
Front Public Health
.
2020
Jun
;
8
:
264
.
[PubMed]
2296-2565
5.
Kent
RD
.
The uniqueness of speech among motor systems
.
Clin Linguist Phon
.
2004
Sep-Dec
;
18
(
6-8
):
495
505
.
[PubMed]
0269-9206
6.
Zhang
Z
.
Mechanics of human voice production and control
.
J Acoust Soc Am
.
2016
Oct
;
140
(
4
):
2614
35
.
[PubMed]
1520-8524
7.
Ravanbakhsh
M
,
Zamani
P
.
You might transmit COVID-19 via only the talking; A Speech Therapy perspective
.
Health Emerg Disast Q.
2020
;
5
(
3
):
121
2
. 2345-4210
8.
Dejonckere
PH
,
Bradley
P
,
Clemente
P
,
Cornut
G
,
Crevier-Buchman
L
,
Friedrich
G
, et al.;
Committee on Phoniatrics of the European Laryngological Society (ELS)
.
A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Guideline elaborated by the Committee on Phoniatrics of the European Laryngological Society (ELS)
.
Eur Arch Otorhinolaryngol
.
2001
Feb
;
258
(
2
):
77
82
.
[PubMed]
0937-4477
9.
Karnell
MP
,
Melton
SD
,
Childes
JM
,
Coleman
TC
,
Dailey
SA
,
Hoffman
HT
.
Reliability of clinician-based (GRBAS and CAPE-V) and patient-based (V-RQOL and IPVI) documentation of voice disorders
.
J Voice
.
2007
Sep
;
21
(
5
):
576
90
.
[PubMed]
0892-1997
10.
Carding
PN
,
Wilson
JA
,
MacKenzie
K
,
Deary
IJ
.
Measuring voice outcomes: state of the science review
.
J Laryngol Otol
.
2009
Aug
;
123
(
8
):
823
9
.
[PubMed]
1748-5460
11.
Castillo-Allendes
A
,
Contreras-Ruston
F
,
Cantor-Cutiva
LC
,
Codino
J
,
Guzman
M
,
Malebran
C
, et al.
Voice Therapy in the Context of the COVID-19 Pandemic: Guidelines for Clinical Practice
.
J Voice
.
2020
Aug
;S0892-1997(20)30287-3.
[PubMed]
1873-4588
12.
Helou
LB
,
Solomon
NP
,
Henry
LR
,
Coppit
GL
,
Howard
RS
,
Stojadinovic
A
.
The role of listener experience on Consensus Auditory-perceptual Evaluation of Voice (CAPE-V) ratings of postthyroidectomy voice
.
Am J Speech Lang Pathol
.
2010
Aug
;
19
(
3
):
248
58
.
[PubMed]
1558-9110
13.
Lechien
JR
,
Chiesa-Estomba
CM
,
Cabaraux
P
,
Mat
Q
,
Huet
K
,
Harmegnies
B
, et al.
Features of mild-to-moderate COVID-19 patients with dysphonia
.
J Voice
.
2020
Jun
;S0892-1997(20)30183-1.
[PubMed]
1873-4588
14.
Asiaee
M
,
Vahedian-Azimi
A
,
Atashi
SS
,
Keramatfar
A
,
Nourbakhsh
M
.
Voice quality evaluation in patients with COVID-19: an acoustic analysis
.
J Voice
.
2020
Oct
;S0892-1997(20)30368-4.
[PubMed]
1873-4588
15.
Long
C
,
Xu
H
,
Shen
Q
,
Zhang
X
,
Fan
B
,
Wang
C
, et al.
Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT?
Eur J Radiol
.
2020
May
;
126
:
108961
.
[PubMed]
1872-7727
16.
Hong
KH
,
Lee
SW
,
Kim
TS
,
Huh
HJ
,
Lee
J
,
Kim
SY
, et al.
Guidelines for laboratory diagnosis of Coronavirus Disease (COVID-19) in Korea
.
Ann Lab Med
.
2020
Sep
;
40
(
5
):
351
60
.
[PubMed]
2234-3814
17.
Salary Majd
N
,
Khoddami
M
,
Drinnan
M
,
Kamali
M
,
Amiri-Shavaki
Y
,
Fallahian
N
.
Validity and rater reliability of Persian version of the Consensus Auditory Perceptual Evaluation of Voice
.
Audiol.
2014
;
23
(
3
):
65
74
.
18.
Nemr
K
,
Simões-Zenari
M
,
Cordeiro
GF
,
Tsuji
D
,
Ogawa
AI
,
Ubrig
MT
, et al.
GRBAS and Cape-V scales: high reliability and consensus when applied at different times
.
J Voice
.
2012
Nov
;
26
(
6
):
812.e17
22
.
[PubMed]
1873-4588
19.
Mendes Tavares
EL
,
Brasolotto
AG
,
Rodrigues
SA
,
Benito Pessin
AB
,
Garcia Martins
RH
.
Maximum phonation time and s/z ratio in a large child cohort
.
J Voice
.
2012
Sep
;
26
(
5
):
675.e1
4
.
[PubMed]
1873-4588
20.
Eckel
FC
,
Boone
DR
.
The S/Z ratio as an indicator of laryngeal pathology
.
J Speech Hear Disord
.
1981
May
;
46
(
2
):
147
9
.
[PubMed]
0022-4677
21.
Van der Meer
G
,
Ferreira
Y
,
Loock
JW
.
The S/Z ratio: a simple and reliable clinical method of evaluating laryngeal function in patients after intubation
.
J Crit Care
.
2010
Sep
;
25
(
3
):
489
92
.
[PubMed]
1557-8615
22.
Kempster
GB
,
Gerratt
BR
,
Verdolini Abbott
K
,
Barkmeier-Kraemer
J
,
Hillman
RE
.
Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol
.
Am J Speech Lang Pathol
.
2009
May
;
18
(
2
):
124
32
.
[PubMed]
1058-0360
23.
Boersma
P
,
van Heuven
V
.
Speech and unspeak with Praat.
Glot International. UK: Blackwell Publishers Ltd;
2001
:9-10,15.
24.
Bartko
J
.
On various intra-class correlation reliability coefficient
.
Psychol Bull
.
1976
;
83
(
5
):
762
5
. 0033-2909
25.
Solomon
NP
,
Helou
LB
,
Stojadinovic
A
.
Clinical versus laboratory ratings of voice using the CAPE-V
.
J Voice
.
2011
Jan
;
25
(
1
):
e7
14
.
[PubMed]
1873-4588
26.
Gorris C, Maccarini AR, Vanoni F, Poggioli M, Vaschetto R, Garzaro M, Valletti PA. Acoustic analysis of normal voice patterns in Italian adults by using Praat. J Voice. 2020 Nov;34(6):961.e9–961.e18.
27.
Gorris
C
,
Maccarini
AR
,
Vanoni
F
,
Poggioli
M
,
Vaschetto
R
,
Garzaro
M
, et al.
Prevalence of dysphonia in non-hospitalized patients with COVID-19 in Lombardy, the Italian epicenter of the pandemic
.
J Voice
.
2021
Mar
; 0892-1997
28.
Faham
M
,
Pirizadeh
H
,
Vahab
M
,
Mehravaran
M
,
Ahmadi
A
.
Comparison of respiratory competency based on MPT and s/z Ratio in teachers with/without voice disorders risk based on SIVD
.
J Rehabil Med
.
2016
;
5
(
3
):
119
26
.1650-1977
29.
Maslan
J
,
Leng
X
,
Rees
C
,
Blalock
D
,
Butler
SG
.
Maximum phonation time in healthy older adults
.
J Voice
.
2011
Nov
;
25
(
6
):
709
13
.
[PubMed]
1873-4588
30.
Gelfer
MP
,
Pazera
JF
.
Maximum duration of sustained /s/ and /z/ and the s/z ratio with controlled intensity
.
J Voice
.
2006
Sep
;
20
(
3
):
369
79
.
[PubMed]
0892-1997
31.
Mathur
P
,
Vishwakarma
C
,
Sinha
V
,
Vishwakarma
R
,
Pandey
A
,
Thakur
P
.
Efficacy of voice therapy in teachers: using perceptual assessment protocol
.
Indian J Otol.
2015
;
21
(
2
):
149
53
. 0971-7749
32.
Speyer
R
,
Bogaardt
HC
,
Passos
VL
,
Roodenburg
NP
,
Zumach
A
,
Heijnen
MA
, et al.
Maximum phonation time: variability and reliability
.
J Voice
.
2010
May
;
24
(
3
):
281
4
.
[PubMed]
1873-4588
33.
Banjara
H
,
Mungutwar
V
,
Singh
D
,
Gupta
A
.
Objective and subjective evaluation of larynx in smokers and nonsmokers: a comparative study
.
Indian J Otolaryngol Head Neck Surg
.
2014
Jan
;
66
(
S1
Suppl 1
):
99
109
.
[PubMed]
2231-3796
34.
Brosnahan
SB
,
Jonkman
AH
,
Kugler
MC
,
Munger
JS
,
Kaufman
DA
.
COVID-19 and respiratory system disorders: current knowledge, future clinical and translational research questions
.
Arterioscler Thromb Vasc Biol
.
2020
Nov
;
40
(
11
):
2586
97
.
[PubMed]
1524-4636
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