Hoarseness: How Likely Is It to Be a COVID Symptom?

With the presence of COVID-19 on a global scale, it has only been natural to wonder if any symptom you develop could be a sign of the illness. And, while a cough, sore throat, or loss of taste and smell should raise a red flag, there are some symptoms that fall into a gray zone—with hoarseness being one of them.

If you're experiencing hoarseness, your voice can sound breathy, raspy, or strained, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). It will usually be softer in volume or lower in pitch, and your throat might feel scratchy. Hoarseness is usually a symptom of problems in the vocal folds of your larynx, or your voice box.

Dubbed "COVID voice," some people with the virus have reported developing a raspy voice. But should you panic that you could have COVID if you suddenly develop hoarseness? Here's what you need to know.

What's the Link Between Hoarseness and COVID?

There is some data to show that COVID is associated with hoarseness. (Per StatPearls, dysphonia is a catch-all term for trouble speaking that includes having hoarseness.) This was rated as mild to moderate in 69 of the patients. But it lasted for more than two weeks for 33 of the individuals and for more than a month in 11 study participants.

Another study published in the Journal of Voice in June 2020 analyzed data from 702 patients with mild to moderate COVID-19 across 19 hospitals in Europe. Of those, 188 (or about 27%) had dysphonia. "Dysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection," the researchers wrote.

However, in COVID cases where hoarseness occurs, it's important to point out that hoarseness isn't unique to COVID. "It is very common for respiratory viruses to cause hoarseness," infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security in Maryland, told Health. "This is not something specific to COVID-19 but a general complication of many upper respiratory infections."

Why Might People With COVID Experience Hoarseness?

Upper respiratory infections, including COVID, can cause a sore throat, Dr. Adalja said. That could be the result of inflammation of the vocal cords themselves or post-nasal drip "which can lead to changes in the voice," Dr. Adalja explained.

Coughing—a major symptom of COVID—"can certainly also exacerbate the larynx and lead to hoarseness," William Schaffner, MD, an infectious-disease specialist and professor at the Vanderbilt University School of Medicine, told Health.

Coughing can specifically lead to inflammation that makes your vocal cords swollen and less flexible, Omid Mehdizadeh, MD, an otolaryngologist and laryngologist at Providence Saint John's Health Center in Santa Monica, Calif., told Health. When that happens, it can affect the pitch of your voice and make it sound hoarse, Dr. Mehdizadeh said. "Any type of inflammation in the vocal chords can cause hoarseness," Dr. Mehdizadeh pointed out.

If you happen to have a more severe case of COVID-19 and are treated with the steroid dexamethasone, you could develop acid reflux, which can irritate your throat and lead to hoarseness, Dr. Mehdizadeh said: "Steroids in general can cause acid reflux."

Ultimately though, most of these factors that can cause hoarseness are likely to develop after you've developed other signs of COVID. In other words, suddenly developing hoarseness is unlikely to be an early sign that you have the virus.

What to Do if Your Voice Becomes Hoarse

"If you develop a hoarse voice, don't assume it's due to COVID-19 unless you have other symptoms," Dr. Schaffner advised.

If you happen to develop hoarseness and you don't have any pain, shortness of breath, or obvious swelling, Dr. Mehdizadeh recommended doing your best to stay hydrated, speak as little as possible, and rest your voice. "People tend to try to push through the hoarseness and that could potentially injure the vocal cords," Dr. Mehdizadeh said.

Per the NIDCD, you should contact your healthcare provider if, along with your hoarseness, you:

• Cough up blood
• Have difficulty or pain with swallowing
• Feel a lump in your neck
• Have difficulty breathing
• Lose your voice beyond a few days

A Quick Review

While a hoarse voice could be a symptom of COVID, it is not likely to be an early symptom or a cause for concern. You can develop a hoarse voice for reasons other than COVID, such as another upper respiratory disease. If you have hoarseness that lasts for more than two weeks and there isn't an obvious reason (like COVID-19 or another upper respiratory tract infection), Dr. Mehdizadeh recommended seeing your healthcare provider for evaluation.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.