COVID-related dysphonia and persistent long-COVID voice sequelae: A systematic review and meta-analysis

Purpose: Dysphonia is a common symptom due to coronavirus disease 2019 (COVID-19) infection but is often underestimated. We investigated the global prevalence of COVID-related dysphonia and related clinical factors during acute infection and after mid- to long-term follow-up following recovery. Methods: PubMed, Embase, ScienceDirect, Cochrane Library, and Web of Science were searched through December 2022; references of included studies were also reviewed. Dysphonia prevalence during and after COVID-19 and voice-related clinical factors were analyzed using a random-effects model. One-study-removal sensitivity analysis was conducted; publication bias was assessed with funnel plots and Egger’s tests. Results: Twenty-one articles comprising 13,948 patients were identified. The weighted prevalence of dysphonia during infection was 25.1% (95% CI: 14.9–39.0%), with male sex associated with lower prevalence (coefficient −0.116, 95% CI: −0.196 to −0.036; P = .004). After recovery, the weighted prevalence declined to 17.1% (95% CI: 11.0–25.8%). In studies with at least 3 months’ follow-up (long-COVID), 20.1% (95% CI: 8.6–40.2%) had persistent dysphonia. Conclusions: About one quarter of COVID-19 patients, especially females, experience dysphonia during infection, and approximately 70% of these dysphonic patients continue to have long-lasting voice sequelae, warranting clinical attention.