Swallowing and Voice Outcomes in Patients Hospitalized With COVID-19: An Observational Cohort Study.
Sally K Archer, Christina M Iezzi, Louisa Gilpin
PMID 33529610WHAT IT FOUND
Most patients referred to speech therapy for COVID-19 swallowing or voice problems improved significantly.
Nearly all resumed oral intake within days and were decannulated, but more than half still had voice issues on discharge, requiring specific outpatient follow-up pathways.
Key findings
01The majority of patients with tracheostomies were successfully decannulated during the study, with a median time of 19 days and no failed decannulations.
02While swallowing function improved significantly for most patients, over half of those with initial voice impairment remained dysphonic at hospital discharge.
03Instrumental swallowing assessments were not performed due to infection control guidelines, meaning management relied entirely on clinical assessment and compensatory strategies.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was conducted in a single center with a high critical care capacity, meaning the sample was skewed toward severe cases and may not represent milder COVID-19 presentations. Only patients referred to SLT were included, so the true prevalence of swallowing and voice disorders in the general COVID-19 population is unknown. Infection control guidelines prevented the use of instrumental assessments (FEES), so diagnoses and management relied on clinical judgment, which may have missed subtle impairments. Outcome data were missing for many patients due to death, transfer to other facilities, or inability to assess, leading to variable sample sizes for different measures. Measurements were taken by treating therapists without blinding, introducing a risk of observer bias. The study did not track long-term outcomes beyond hospital discharge, so the duration of voice and swallowing recovery in the community is unknown.
Declared interests
None declared.
The easy way to misread this
Do not assume that all patients referred to SLT for COVID-19 will have fully resolved voice issues by discharge. While swallowing improved rapidly for most, over half of the intubated patients with initial dysphonia still had voice problems when they left the hospital, requiring ongoing specialist follow-up.