Investigating the Prevalence of Dysphagia and Dysphonia in Patients with COVID-19 in the Intensive Care Unit
,
Abstract
Introduction: The world has been suffering from COVID-19 since 2020 and the disease continues up to now. COVID-19 patients are at high risk of dysphagia and dysphonia. Accordingly, this study aims to determine the prevalence of dysphonia and dysphagia and identify correlated factors to develop dysphagia and dysphonia in COVID-19 patients admitted to intensive care units (ICU).
Materials and Methods: A total of 70 patients with COVID-19 (Mean±SD age of 63.1±18.6; males=39) hospitalized in ICUs were evaluated by an expert on speech and language. The patients were evaluated for swallowing disorder via the Mann assessment of swallowing ability and the Persian version of the functional oral intake scale. The consensus auditory-perceptual evaluation of voice was also used to evaluate voice disorders.
Results: Overall, 58.6% of patients presented dysphagia and 74.3% of patients had dysphonia. Meanwhile, 34.3% of the patients were on mechanical ventilation. A correlation was detected between dysphagia severity and the number of mechanical ventilation days, the length of stay, and age (P<0.05). Dyspnea impacts the prevalence of dysphonia and dysphagia in COVID-19 patients (P<0.05). Vomiting has been effective on only the prevalence of dysphagia (P<0.05). Furthermore, a significant correlation was found between dysphagia and dysphonia (P<0.01).
Conclusion: A high prevalence rate of dysphagia and dysphonia exists in patients with COVID-19 admitted to ICUs. An early evaluation by a speech and language pathologist is essential to identify the suspected patients and provide early intervention to prevent further complications and improve their quality of life.
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15. 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. Journal of Voice. 2022;36(2):249-55. [DOI:10.1016/j.jvoice.2020.05.012]
16. Aghaz A, Shahriyari A, Panahiaboozar S, Jadidi H, Khoshgoftar M, Choupani E, et al. Prevalence of Dysphonia in Patients with COVID-19: A Systematic Review and Meta-Analysis. Modern Rehabilitation. 2022;16(2). [DOI:10.18502/jmr.v16i2.9299]
17. Regan J, Walshe M, Lavan S, Horan E, Murphy PG, Healy A, et al. Dysphagia, Dysphonia, and Dysarthria Outcomes Among Adults Hospitalized With COVID‐19 Across Ireland. The Laryngoscope. 2022;132(6):1251-9. [DOI:10.1002/lary.29900]
18. Martin–Martinez A, Ortega O, Viñas P, Arreola V, Nascimento W, Costa A, et al. COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic. Clinical Nutrition. 2022;41(12):2996-3006. [DOI:10.1016/j.clnu.2021.06.010]
19. Al-Ani RM, Rashid RA. Prevalence of dysphonia due to COVID-19 at Salahaddin General Hospital, Tikrit City, Iraq. American Journal of Otolaryngology. 2021;42(5):103157. [DOI:10.1016/j.amjoto.2021.103157]
20. Salary Majd N, Maryam Khoddami S, Drinnan M, Kamali M, Amiri-Shavaki Y, Fallahian N. Validity and rater reliability of Persian version of the Consensus Auditory Perceptual Evaluation of Voice. Audiology. 2014;23(3).
21. Mizuta M, Abe C, Taguchi E, Takeue T, Tamaki H, Haji T. Validation of cepstral acoustic analysis for normal and pathological voice in the Japanese language. Journal of Voice. 2022;36(6):770-6. [DOI: 10.1016/j.jvoice.2020.08.026]
22. Ansari NN, Tarameshlu M, Ghelichi L. Dysphagia in multiple sclerosis patients: diagnostic and evaluation strategies. Degenerative neurological and neuromuscular disease. 2020:15-28. [DOI:10.2147/DNND.S198659]
23. 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. Journal of Voice. 2007;21(5):576-90. [DOI:10.1016/j.jvoice.2006.05.001]
24. Lindh MG, Mattsson G, Koyi H, Johansson MB, Razmi R, Palm A. Swallowing function in COVID-19 patients after invasive mechanical ventilation. Archives of Rehabilitation Research and Clinical Translation. 2022;4(1):100177. [DOI:10.1016/j.arrct.2021.100177]
25. Bakhtiyari J, Tohidast SA, Mansuri B, Azimi H, Ebadi A. The Persian version of the Functional Oral Intake Scale (FOIS-P): a validation study on stroke patients with dysphagia. Logopedics Phoniatrics Vocology. 2022;47(2):133-8. [DOI:10.1080/14015439.2021.1896778]
26. Fernández-Ruiz VE, Paredes-Ibáñez R, Armero-Barranco D, Sánchez-Romera JF, Ferrer M. Analysis of quality of life and nutritional status in elderly patients with dysphagia in order to prevent hospital admissions in a COVID-19 pandemic. Life. 2020;11(1):22. [DOI:10.3390/life11010022]
27. Reyes‐Torres CA, Flores‐López A, Osuna‐Padilla IA, Hernández‐Cárdenas CM, Serralde‐Zúñiga AE. Phase angle and overhydration are associated with post‐extubating dysphagia in patients with COVID‐19 discharged from the ICU. Nutrition in Clinical Practice. 2022;37(1):110-6. [DOI:10.1002/ncp.10781]
28. Mallart R, Rossignol C, Poppe J, Prum G, Tamion F, Veber B, et al. Prevalence and evaluation of oropharyngeal dysphagia in SARS-CoV2 infection in intensive care unit. The Journal of Laryngology and Otology. 2022:1-14. [DOI:10.1017/S0022215121004710]
29. Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest. 2010;137(3):665-73. [DOI:10.1378/chest.09-1823]
30. Malandraki GA, Markaki V, Georgopoulos VC, Psychogios L, Nanas S. Postextubation dysphagia in critical patients: a first report from the largest step-down intensive care unit in Greece. American journal of speech-language pathology. 2016;25(2):150-6. [DOI: 10.1044/2015_AJSLP-14-0069.]
31. Laguna LB, Marcos-Neira P, de Lagrán Zurbano IM, Marco EM, Guisasola CP, Soria CDV, et al. Dysphagia and mechanical ventilation in SARS-COV-2 pneumonia: It's real. Clinical Nutrition. 2022;41(12):2927-33. [DOI:10.1016/j.clnu.2021.11.018]
32. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clinical interventions in aging. 2012:287-98. [DOI:10.2147/CIA.S23404]
33. Elibol E. Otolaryngological symptoms in COVID-19. European Archives of Oto-Rhino-Laryngology. 2021;278:1233-6. [DOI:10.1007/s00405-020-06319-7]
34. Doblan A, Kaplama ME, Ak S, Basmacı N, Tarini EZ, Göktaş ŞE, et al. Cranial nerve involvement in COVID-19. American journal of otolaryngology. 2021;42(5):102999. [DOI:10.1016/j.amjoto.2021.102999]
35. Cantarella G, Aldè M, Consonni D, Zuccotti G, Di Berardino F, Barozzi S, et al. Prevalence of Dysphonia in Non hospitalized Patients with COVID-19 in Lombardy, the Italian Epicenter of the Pandemic. Journal of Voice. 2021. [DOI:10.1016/j.jvoice.2021.03.009]
36. Chen Y, Linli Z, Lei Y, Yang Y, Liu Z, Xia Y, et al. Risk factors for mortality in critically ill patients with COVID‐19 in Huanggang, China: A single‐center multivariate pattern analysis. Journal of Medical Virology. 2021;93(4):2046-55. [DOI:10.1002/jmv.26572]
37. Speth MM, Singer-Cornelius T, Oberle M, Gengler I, Brockmeier SJ, Sedaghat AR. Olfactory dysfunction and sinonasal symptomatology in COVID-19: prevalence, severity, timing, and associated characteristics. Otolaryngology–Head and Neck Surgery. 2020;163(1):114-20. [DOI:10.1177/0194599820929185]
38. Paderno A, Mattavelli D, Rampinelli V, Grammatica A, Raffetti E, Tomasoni M, et al. Olfactory and gustatory outcomes in COVID‐19: a prospective evaluation in nonhospitalized subjects. Otolaryngology–Head and Neck Surgery. 2020;163(6):1144-9. [DOI:10.1177/0194599820939538]
39. 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. Journal of Voice. 2020. [DOI:10.1016/j.jvoice.2020.05.012]
40. Mezzedimi C, Vinci E, Giannini F, Cocca S. Correlation between dysphonia and dysphagia evolution in amyotrophic lateral sclerosis patients. Logopedics Phoniatrics Vocology. 2021;46(3):118-25. [DOI:10.1080/14015439.2020.1771766]
41. Osbeck Sandblom H, Dotevall H, Svennerholm K, Tuomi L, Finizia C. Characterization of dysphagia and laryngeal findings in COVID-19 patients treated in the ICU—An observational clinical study. PLoS One. 2021;16(6):e0252347. [DOI:10.1371/journal.pone.0252347]
2. Sourtiji H, Khalaji M, Monfared E. Telerehabilitation in People with Multiple Sclerosis: A Scoping Review. Journal of Modern Rehabilitation. 2023;17(1):1-10. [DOI:10.18502/jmr.v17i1.11289]
3. Marchese MR, Ausili Cefaro C, Mari G, Proietti I, Carfì A, Tosato M, et al. Oropharyngeal dysphagia after hospitalization for COVID-19 disease: our screening results. Dysphagia. 2022;37(2):447-53. [DOI:10.1007/s00455-021-10325-0]
4. wenzhong l, hualan l. COVID-19: Attacks Immune Cells and Interferences with Antigen Presentation through MHC-Like Decoy System. [DOI:10.26434/chemrxiv-2021-m7456]
5. Islam S, Islam T, Islam MR. New coronavirus variants are creating more challenges to global healthcare system: a brief report on the current knowledge. Clinical pathology. 2022;15:2632010X221075584. [DOI:10.1177/2632010X221075584]
6. Regan J, Walshe M, Lavan S, Horan E, Gillivan Murphy P, Healy A, et al. Post‐extubation dysphagia and dysphonia amongst adults with COVID‐19 in the Republic of Ireland: A prospective multi‐site observational cohort study. Clinical Otolaryngology. 2021;46(6):1290-9. [DOI:10.1111/coa.13832]
7. Frajkova Z, Tedla M, Tedlova E, Suchankova M, Geneid A. Postintubation dysphagia during COVID-19 outbreak-contemporary review. Dysphagia. 2020;35:549-57. [DOI:10.1007/s00455-020-10139-6]
8. Abate SM, Ahmed Ali S, Mantfardo B, Basu B. Rate of Intensive Care Unit admission and outcomes among patients with coronavirus: A systematic review and Meta-analysis. PloS one. 2020;15(7):e0235653. [DOI:10.1371/journal.pone.0235653]
9. Archer SK, Iezzi CM, Gilpin L. Swallowing and voice outcomes in patients hospitalized with COVID-19: an observational cohort study. Archives of Physical Medicine and Rehabilitation. 2021;102(6):1084-90. [DOI:10.1016/j.apmr.2021.01.063]
10. Cichero JA, Altman KW. Definition, prevalence and burden of oropharyngeal dysphagia: a serious problem among older adults worldwide and the impact on prognosis and hospital resources. Stepping stones to living well with dysphagia. 72: Karger Publishers; 2012. p. 1-11. [DOI:10.1159/000339974]
11. Eyigör S, Umay E. Dysphagia management during COVID-19 pandemic: A review of the literature and international guidelines. Turkish journal of physical medicine and rehabilitation. 2021;67(3):267. [DOI:10.5606/tftrd.2021.8427]
12. Schwartz SR, Cohen SM, Dailey SH, Rosenfeld RM, Deutsch ES, Gillespie MB, et al. Clinical practice guideline: hoarseness (dysphonia). Otolaryngology–Head and Neck Surgery. 2009;141(1_suppl):1-31. [DOI:10.1016/j.otohns.2009.06.744]
13. Asiaee M, Vahedian-Azimi A, Atashi SS, Keramatfar A, Nourbakhsh M. Voice quality evaluation in patients with COVID-19: An acoustic analysis. Journal of Voice. 2022;36(6):879. e13-. e19. [DOI:10.1016/j.jvoice.2020.09.024]
14. Leis-Cofiño C, Arriero-Sánchez P, González-Herranz R, Arenas-Brítez Ó, Hernández-García E, Plaza G. Persistent dysphonia in hospitalized COVID-19 patients. Journal of Voice. 2021. [DOI:10.1016/j.jvoice.2021.07.001]
15. 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. Journal of Voice. 2022;36(2):249-55. [DOI:10.1016/j.jvoice.2020.05.012]
16. Aghaz A, Shahriyari A, Panahiaboozar S, Jadidi H, Khoshgoftar M, Choupani E, et al. Prevalence of Dysphonia in Patients with COVID-19: A Systematic Review and Meta-Analysis. Modern Rehabilitation. 2022;16(2). [DOI:10.18502/jmr.v16i2.9299]
17. Regan J, Walshe M, Lavan S, Horan E, Murphy PG, Healy A, et al. Dysphagia, Dysphonia, and Dysarthria Outcomes Among Adults Hospitalized With COVID‐19 Across Ireland. The Laryngoscope. 2022;132(6):1251-9. [DOI:10.1002/lary.29900]
18. Martin–Martinez A, Ortega O, Viñas P, Arreola V, Nascimento W, Costa A, et al. COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic. Clinical Nutrition. 2022;41(12):2996-3006. [DOI:10.1016/j.clnu.2021.06.010]
19. Al-Ani RM, Rashid RA. Prevalence of dysphonia due to COVID-19 at Salahaddin General Hospital, Tikrit City, Iraq. American Journal of Otolaryngology. 2021;42(5):103157. [DOI:10.1016/j.amjoto.2021.103157]
20. Salary Majd N, Maryam Khoddami S, Drinnan M, Kamali M, Amiri-Shavaki Y, Fallahian N. Validity and rater reliability of Persian version of the Consensus Auditory Perceptual Evaluation of Voice. Audiology. 2014;23(3).
21. Mizuta M, Abe C, Taguchi E, Takeue T, Tamaki H, Haji T. Validation of cepstral acoustic analysis for normal and pathological voice in the Japanese language. Journal of Voice. 2022;36(6):770-6. [DOI: 10.1016/j.jvoice.2020.08.026]
22. Ansari NN, Tarameshlu M, Ghelichi L. Dysphagia in multiple sclerosis patients: diagnostic and evaluation strategies. Degenerative neurological and neuromuscular disease. 2020:15-28. [DOI:10.2147/DNND.S198659]
23. 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. Journal of Voice. 2007;21(5):576-90. [DOI:10.1016/j.jvoice.2006.05.001]
24. Lindh MG, Mattsson G, Koyi H, Johansson MB, Razmi R, Palm A. Swallowing function in COVID-19 patients after invasive mechanical ventilation. Archives of Rehabilitation Research and Clinical Translation. 2022;4(1):100177. [DOI:10.1016/j.arrct.2021.100177]
25. Bakhtiyari J, Tohidast SA, Mansuri B, Azimi H, Ebadi A. The Persian version of the Functional Oral Intake Scale (FOIS-P): a validation study on stroke patients with dysphagia. Logopedics Phoniatrics Vocology. 2022;47(2):133-8. [DOI:10.1080/14015439.2021.1896778]
26. Fernández-Ruiz VE, Paredes-Ibáñez R, Armero-Barranco D, Sánchez-Romera JF, Ferrer M. Analysis of quality of life and nutritional status in elderly patients with dysphagia in order to prevent hospital admissions in a COVID-19 pandemic. Life. 2020;11(1):22. [DOI:10.3390/life11010022]
27. Reyes‐Torres CA, Flores‐López A, Osuna‐Padilla IA, Hernández‐Cárdenas CM, Serralde‐Zúñiga AE. Phase angle and overhydration are associated with post‐extubating dysphagia in patients with COVID‐19 discharged from the ICU. Nutrition in Clinical Practice. 2022;37(1):110-6. [DOI:10.1002/ncp.10781]
28. Mallart R, Rossignol C, Poppe J, Prum G, Tamion F, Veber B, et al. Prevalence and evaluation of oropharyngeal dysphagia in SARS-CoV2 infection in intensive care unit. The Journal of Laryngology and Otology. 2022:1-14. [DOI:10.1017/S0022215121004710]
29. Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest. 2010;137(3):665-73. [DOI:10.1378/chest.09-1823]
30. Malandraki GA, Markaki V, Georgopoulos VC, Psychogios L, Nanas S. Postextubation dysphagia in critical patients: a first report from the largest step-down intensive care unit in Greece. American journal of speech-language pathology. 2016;25(2):150-6. [DOI: 10.1044/2015_AJSLP-14-0069.]
31. Laguna LB, Marcos-Neira P, de Lagrán Zurbano IM, Marco EM, Guisasola CP, Soria CDV, et al. Dysphagia and mechanical ventilation in SARS-COV-2 pneumonia: It's real. Clinical Nutrition. 2022;41(12):2927-33. [DOI:10.1016/j.clnu.2021.11.018]
32. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clinical interventions in aging. 2012:287-98. [DOI:10.2147/CIA.S23404]
33. Elibol E. Otolaryngological symptoms in COVID-19. European Archives of Oto-Rhino-Laryngology. 2021;278:1233-6. [DOI:10.1007/s00405-020-06319-7]
34. Doblan A, Kaplama ME, Ak S, Basmacı N, Tarini EZ, Göktaş ŞE, et al. Cranial nerve involvement in COVID-19. American journal of otolaryngology. 2021;42(5):102999. [DOI:10.1016/j.amjoto.2021.102999]
35. Cantarella G, Aldè M, Consonni D, Zuccotti G, Di Berardino F, Barozzi S, et al. Prevalence of Dysphonia in Non hospitalized Patients with COVID-19 in Lombardy, the Italian Epicenter of the Pandemic. Journal of Voice. 2021. [DOI:10.1016/j.jvoice.2021.03.009]
36. Chen Y, Linli Z, Lei Y, Yang Y, Liu Z, Xia Y, et al. Risk factors for mortality in critically ill patients with COVID‐19 in Huanggang, China: A single‐center multivariate pattern analysis. Journal of Medical Virology. 2021;93(4):2046-55. [DOI:10.1002/jmv.26572]
37. Speth MM, Singer-Cornelius T, Oberle M, Gengler I, Brockmeier SJ, Sedaghat AR. Olfactory dysfunction and sinonasal symptomatology in COVID-19: prevalence, severity, timing, and associated characteristics. Otolaryngology–Head and Neck Surgery. 2020;163(1):114-20. [DOI:10.1177/0194599820929185]
38. Paderno A, Mattavelli D, Rampinelli V, Grammatica A, Raffetti E, Tomasoni M, et al. Olfactory and gustatory outcomes in COVID‐19: a prospective evaluation in nonhospitalized subjects. Otolaryngology–Head and Neck Surgery. 2020;163(6):1144-9. [DOI:10.1177/0194599820939538]
39. 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. Journal of Voice. 2020. [DOI:10.1016/j.jvoice.2020.05.012]
40. Mezzedimi C, Vinci E, Giannini F, Cocca S. Correlation between dysphonia and dysphagia evolution in amyotrophic lateral sclerosis patients. Logopedics Phoniatrics Vocology. 2021;46(3):118-25. [DOI:10.1080/14015439.2020.1771766]
41. Osbeck Sandblom H, Dotevall H, Svennerholm K, Tuomi L, Finizia C. Characterization of dysphagia and laryngeal findings in COVID-19 patients treated in the ICU—An observational clinical study. PLoS One. 2021;16(6):e0252347. [DOI:10.1371/journal.pone.0252347]
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| Issue | Vol 17 No 4 (2023) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v17i4.13894 | |
| Keywords | ||
| Prevalence COVID-19 Dysphagia Dysphonia Intensive care unit | ||
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How to Cite
1.
Banari A, Aghaz A, Shahriyari A, Noori S, Pourmohammadi M. Investigating the Prevalence of Dysphagia and Dysphonia in Patients with COVID-19 in the Intensive Care Unit. jmr. 2023;17(4):450-460.
