If there is any silver lining to the recent pandemic, it’s that data about that pandemic, and by possible extension other pandemics, has accrued across every medical discipline. That includes speech and language pathology. An observational cohort study* in London’s Guy's and St Thomas Hospital, a large inner-city National Health Service facility, recently evaluated presentations and outcomes in inpatients with COVID-19, particularly with regard to dysphonia and dysphagia. The investigation was part of an effort to inform potential pathways for ongoing care.
The patient cohort consisted of all adults hospitalized who were also referred to Speech and Language Therapy (SLT) for voice and/or swallowing assessment for 2 months starting in April 2020.
Patients (N=164; 104 men) aged 56.8±16.7 years were assessed. Half (52.4%) had a tracheostomy, 78.7% had been intubated, 13.4% had new neurologic impairment, and 69.5% were delirious. Compensatory strategies were undertaken in all patients, and direct exercises undertaken with 11%. Baseline assessments showed marked impairments in dysphagia and voice, but there was significant improvement in all patients in the course of the study. Most patients were eating and drinking normally on discharge, but 29.3% of those with dysphagia and 56.1% of those with dysphonia remained impaired. 70.9% of the tracheostomized patients were decannulated, median time 19 days. 37.3% in all completed SLT. 23.5% were transferred to another hospital, 17.1% had ongoing voice therapy, and 7.8% required follow-up for dysphagia.
COVID-19 patients can present with significant impairments in voice and swallowing, is the lesson. And they typically improve with assessment and individualized compensatory strategies. Services preparing for COVID-19 should be prepared for tracheostomy weaning, and referral pathways for dysphagia and dysphonia.
*Archer SK, Iezzi CM, Gilpin L. Swallowing and Voice Outcomes in Patients Hospitalized With COVID-19: An Observational Cohort Study. Arch Phys Med Rehabil. 2021 Jun;102(6):1084-1090. doi: 10.1016/j.apmr.2021.01.063.
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