# Objective and Subjective Voice Outcomes in Post-COVID-19 Dysphonia: A High-Speed Videoendoscopy Pre–Post Study

## TL;DR

This study examines voice changes in post-COVID-19 patients and finds that a combination therapy improves both objective and subjective voice outcomes.

## Contribution

The study introduces a multimodal treatment approach for post-COVID-19 dysphonia and demonstrates its effectiveness using high-speed videoendoscopy.

## Key findings

- High-speed videoendoscopy showed improved vocal fold oscillation and symmetry after treatment.
- Patient-reported outcomes like VHI and V-RQOL scores improved significantly.
- Multimodal therapy was associated with reduced perturbation indices and better mucosal wave patterns.

## Abstract

Background/Objectives: The post-COVID-19 condition frequently includes dysphonia. We aimed to assess objective and subjective voice disorders and short-term responses to multimodal therapy in patients with isolated post-COVID-19 dysphonia. Methods: This retrospective, single-center pre–post study screened 244 post-COVID-19 patients; a subset of 14 with isolated dysphonia underwent standardized assessment at baseline and at 1-month follow-up. Patient-reported outcomes (Voice Handicap Index, VHI; Voice-Related Quality of Life, V-RQOL) and endoscopic evaluation were performed using videolaryngostroboscopy (LVS) and high-speed videoendoscopy (HSV) with kymographic analysis to quantify parameters describing vocal fold oscillations. The treatment included short-term systemic corticosteroids, inhaled corticosteroids, hyaluronic-acid inhalations, and structured voice therapy. Results: At baseline, HSV revealed signs of glottal insufficiency—irregular and asymmetric vocal fold motion, reduced amplitude and pliability, a disrupted mucosal wave, and an increased open quotient. At follow-up, HSV showed increased oscillation, amplitude, and cycle regularity with reduced left–right asymmetry and phase differences; phonovibrograms displayed clearer and more structured patterns. Perturbation indices decreased across jitter and shimmer measures, and the mean fundamental frequency was lower. Improvements in instrumental measures aligned with better VHI and V-RQOL scores. Conclusions: In patients with persistent dysphonia after acute SARS-CoV-2 infection, comprehensive ENT evaluation with instrumental laryngeal assessment is warranted. Short-term multimodal management was associated with improvements in both HSV-derived measures and patient-reported outcomes; confirmation in controlled studies is needed.