What is the management of dysphonia (voice disorder) for a singer after a post-viral infection?

Management of Dysphonia for a Singer Post Viral Infection

Voice therapy and vocal hygiene measures should be the primary treatment approach for singers with post-viral dysphonia, with laryngoscopy performed if symptoms persist beyond 3 weeks to rule out serious underlying conditions. 1

Initial Assessment and Management

Timeframe for Intervention

• Most viral laryngitis symptoms typically resolve within 1-3 weeks with appropriate rest and care 1
• Initial observation is reasonable for new-onset dysphonia following viral infection
• If dysphonia persists beyond 3 weeks, visualization of the larynx (laryngoscopy) is essential to refine diagnosis and direct appropriate treatment 1

Special Considerations for Singers

• Professional voice users, especially singers, require more urgent and specialized care due to:
  • Higher vocal demands and performance requirements
  • Greater anxiety about voice problems 1
  • Economic impact of voice disorders on their livelihood
  • Potential detection of subtle voice changes that may not be apparent to non-singers 1

First-Line Management Strategies

Vocal Rest and Hygiene

• Vocal rest: Allow the vocal folds to heal by limiting voice use initially
• Hydration: Maintain adequate hydration to decrease tissue injury and reduce vocal fatigue 1
  • Absence of water intake is associated with 60% higher risk of dysphonia
  • Hydration decreases phonatory effort and vocal fatigue in singers

Things to Avoid During Recovery 1

1. Smoking and secondhand smoke exposure
2. Voice overuse (yelling, shouting, speaking over loud noises, whispering)
3. Excessive throat clearing and coughing
4. Alcohol and caffeine consumption (causes throat dryness and mucous thickening)
5. Drying medications

Physical Activity

• Regular physical exercise (≥3 times/week) is associated with lower prevalence of dysphonia 1
• Consider gentle physical activity as part of recovery regimen

Voice Therapy Techniques for Singers

If symptoms persist beyond initial rest period, voice therapy with a speech-language pathologist (SLP) is recommended. Effective techniques include 1:

Symptomatic Approaches

• Natural reflexive behaviors with sound:
  • Gentle sighs and yawns
  • Comfort moaning sounds
  • Slow, easy onset with prolonged speech sounds
• Vocal exercises:
  • Gentle sirens using nasal sounds (m/n/ng)
  • Low-pitched glottal fry at bottom of vocal range
  • Rising and falling scales on tongue trills
• Physical/postural techniques:
  • Laryngeal repositioning and massage with concurrent vocalization
  • Postural manipulations (phonating while bending over or looking up)

When to Escalate Care

Indications for Laryngoscopy 1

• Dysphonia persisting >3 weeks after viral infection
• Symptoms worsening rather than improving
• Professional voice user (especially singers) with significant concerns
• Presence of additional concerning symptoms:
  • Pain with voice use
  • Complete voice loss (aphonia)
  • Difficulty breathing
  • Hemoptysis

COVID-19 Specific Considerations

Recent research shows that COVID-19 can cause significant vocal fold issues:

• 25.1% of COVID-19 patients experience dysphonia during infection 2
• Approximately 17.1% continue to experience voice issues after recovery 2
• Female patients are more likely to experience COVID-related dysphonia 2
• Post-COVID dysphonia may require more intensive treatment including short-term systemic steroids in some cases 3

Treatment Outcomes and Follow-up

• Document resolution, improvement, or worsening of symptoms after treatment 1
• Follow-up should continue until dysphonia has resolved or underlying condition has been diagnosed and appropriately managed
• For persistent dysphonia, an underlying diagnosis must be sought 1

Common Pitfalls to Avoid

1. Delayed referral: Singers often need earlier specialist evaluation than general population
2. Antibiotic misuse: Antibiotics are not indicated for viral laryngitis and may have unintended consequences 1
3. Inadequate hydration: Critical for vocal fold health, especially in singers
4. Returning to full vocal load too quickly: Gradual return to singing is essential
5. Ignoring environmental factors: Poor air quality, excessive background noise, and dryness can exacerbate dysphonia 1

Remember that singers may detect subtle voice changes that are not apparent to others, and these concerns should be taken seriously given the professional implications of even minor vocal impairments.