Voice and the COVID-19 Pandemic

By: Amanda Bostwick, Paige Nelson, and Sydney Simon

It is now over a year since the World Health Organization (WHO) declared the novel coronavirus (COVID-19) a global pandemic. Many daily routines are now changed. Before you leave your home, you grab your keys, wallet, and now, your mask. Wearing a mask in public in America was practically unheard of, until it quickly became the norm. And, ith new norms in place, come new obstacles we face.

There is strong literature that supports the hypothesis that humans use motor-patterns of facial structures (i.e.; mouth, nose, eyes, eyebrows, etc) to augment spoken language, and ultimately determine the message of the speaker. Listeners use patterns and visual cues such as the crack of a smile, scrunch of a nose, or a burrow of an eyebrow, to aid in comprehension of the speaker’s utterance. Face shields and surgical masks inhibit these helpful hints from being used, so we must rely more heavily on our voice. Soft spoken people may have to repeat themselves or raise their volume to be heard and understood. This could put extra strain on the vocal cords, potentially leading to changes in voice quality, or even benign lesions such as vocal nodules or polyps. In fact, Hieder et al. found that upwards of 33% of healthcare workers, who don extensive personal protective equipment (PPE; including surgical AND N-95 facemasks), may be experiencing a voice disorder.

Barriers such as masks, other PPE, and plexiglass are impacting humans in a multifactorial way by forcing us to use strategies to increase vocal intensity/loudness but using these can put vocal health in jeopardy. Some tips for maintaining vocal health are as follows:

1. Hydration

a. Making sure that you are consuming plenty of liquids is an easy way to keep the laryngeal vestibule/voice box lubricated for voicing.

b. Recommended hydration is 1 fl. Oz per 1lb. of body weight.

2. Speaking with Increased Respiratory Support

a. To increase and maintain loudness, fill your lungs with a deep breath of air and release the air across the entire utterance.

b. Longer utterances may require additional and deeper breaths, so make sure to incorporate this when your utterance has multiple clauses.

3. Increase respiratory “pump” muscle strength – there are many marketed devices that actually strengthen the breathing muscles that help you achieve voicing. Just search for “expiratory muscle strength trainer” in your internet browser and you will see several options!

Lastly, If you or someone you know is experiencing voice changes or difficulty, an ear, nose and throat (ENT) doctor and a speech-language pathologist (SLP) may be able to help. These individuals specialize in helping people with voice problems, and there are even published guidelines regarding telepractice and teletherapy to help people with voice problems – so even in times of what seems like virtual-everything, there may be help for your voice!


Heider, C. A., Álvarez, M. L., Fuentes‐López, E., González, C. A., León, N. I., Verástegui, D. C., … & Napolitano, C. A. (2020). Prevalence of voice disorders in healthcare workers in the universal masking COVID‐19 era. The Laryngoscope.

Castillo-Allendes, A., Contreras-Ruston, F., Cantor, L., Codino, J., Guzman, M., Malebran, C., … & Behlau, M. (2020). Voice therapy in the context of the covid-19 pandemic; guidelines for clinical practice. Journal of Voice.