Swallowing or voice changes

If you are recovering from coronavirus (COVID-19), you might:

• have problems with your swallowing
• cough when you eat and drink
• notice changes to how your voice sounds

These changes often happen in people who have been very ill with COVID-19 and needed support with breathing (ventilation). This is because the tube that was put into the throat to help with breathing has irritated it.

Swallowing or voice changes are likely to get better without any treatment. However, this can take weeks or months.

If you notice changes to your swallowing, it's important that you talk to your doctor about this.

Swallowing safely

You might find it difficult to swallow some foods, liquids or your saliva (spit) after COVID-19.

Problems with swallowing are unpleasant and can increase the risk of food going down into your lungs rather than into your stomach. This can cause problems, such as chest infections. There are some things that you can do to reduce the risk.

• Sit as upright as possible when you eat or drink. Even if you are in bed, try to set up the bed so that you are as upright as when you sit in a chair.
• Avoid distractions (including talking to people) when you eat and drink. Make sure that you are focused.
• Eat and drink slowly. Take 1 sip or 1 mouthful at a time.
• Avoid eating and drinking when you are tired.
• Have smaller meals more often to allow for tiredness (fatigue).
• Look after your mouth and keep it clean.

Changes to your voice

There are things that you can do to protect your voice and help it recover after COVID-19.

• Always try to use your normal voice. Do not worry if all that comes out is a whisper or croak.
• Avoid straining to force your voice to sound louder.
• Avoid talking over background noise, such as music, television or car engine noise.
• If your voice is no more than a whisper, avoid phone calls and online or video conversations. When your voice starts to improve, avoid long conversations that last more than 5 minutes. Try to use text or email instead.
• It is common for your voice to get tired more quickly than usual. Take a break from talking if your throat feels uncomfortable or sore. A break for 30 to 60 minutes gives your voice time to recover.
• Drink lots of fluids to keep hydrated. This helps your vocal cords to stay lubricated (have enough moisture).
• Use steam inhalations if your throat feels dry. Put hot water in a bowl, lean over the bowl with a towel over your head and breathe in (inhale). Use hot water, but do not use boiling water.
• Try not to keep clearing your throat on purpose. If you need to do this, make it as gentle as possible.
• Take small sips of cold water. This can help with the urge to cough.
• Try to relax when you speak, especially your shoulders, head and neck area. Try to relax your breathing, and breathe through your nose.
• Avoid activities like shouting and singing until your voice returns to normal. These activities can strain your voice. If you enjoy singing, try humming or doing it quietly until your voice is stronger.
• Avoid spicy foods that might cause acid reflux (when acid comes up from your stomach and irritates your throat), drinks that contain caffeine, cigarettes and vaping, and alcohol.

The Royal College of Speech and Language Therapists have lots more information about swallowing and voice changes after COVID, visit www.rcslt.org/speech-and-language-therapy