Swallowing difficulties and voice problems after COVID-19

You may have difficulties eating and drinking after having COVID-19. This can affect your voice and communication. You may also become tired more easily or feel short of breath.

Some people recover from this quickly and do not need much support. But others will need more time and help in their recovery.

Swallowing problems

You naturally hold your breath when you swallow. This stops any food or fluid entering the lungs.

If you have problems breathing after COVID-19, you may:

  • have trouble coordinating breathing and swallowing
  • become short of breath while you are eating or drinking

If you were in hospital or an intensive care unit (ICU), the muscles you use for swallowing may be weaker. It can take time to rebuild strength in these muscles.

There are things you can do to help manage swallowing problems at home.

Eating or drinking comfortably

To help any swallowing difficulties:

Do

  • sit up fully on a supportive chair

  • take small sips or bites

  • eat or drink at a slower pace

  • plan your meals for times when you have more energy - you should be fully awake and alert when you eat

  • stop and rest if you are feeling short of breath or tired

  • eat little and often - 3 smaller meals and 3 snacks every day is recommended

  • try eating softer foods that need to be chewed less

  • limit speaking during meals as this can cause shortness of breath

  • focus on your meal - try to reduce distractions around you

Eating well when recovering from COVID-19

Clearing phlegm from your lungs

When to get medical help

If you need extra help, talk to your:

  • GP - if you are recovering at home
  • hospital care team - if you were treated for COVID-19 in hospital

They can refer you to a speech and language therapist (SLT) or a dietitian, depending on your needs.

An SLT may recommend rehabilitation to improve your swallowing, voice and communication skills.

A dietitian can help if you are not getting enough nutrients because of swallowing problems. Nutrition can affect your recovery and mobility.

Foods high in energy you can eat as you recover

If you are in hospital

Tell your doctor or nurse if you feel more short of breath during or at the end of meals.

If you had a tube to help you to breathe (intubation), you may have difficulty swallowing when the tube comes out.

Swallowing disorders (dysphagia) are common after breathing tubes come out. Talk to your doctor if you continue to have problems eating, drinking and swallowing. They can refer you to an SLT for diagnosis and treatment.

Non-urgent advice: Call your GP for advice if:

you are recovering at home and you:

  • are still having swallowing problems after following the advice on how to eat or drink comfortably
  • are coughing or choking when eating or drinking
  • have a wet or ‘gurgly’ voice after swallowing
  • are feeling a sticking sensation in your throat when eating or drinking
  • have new frequent chest infections

Looking after your mouth

While you were sick with COVID-19, you may have had:

  • a dry or sore mouth
  • cracked lips
  • bad breath

Mouth care is important because it can prevent dryness and infections. It is especially important if you were in hospital and had to use a breathing mask. This is because breathing masks can dry out your mouth.

Caring for your mouth

To care for your mouth:

  • brush your teeth after every meal using a pea-sized amount of toothpaste
  • drink plenty of fluids - take regular small sips
  • use lip balm if your lips are dry

If you wear dentures, remove them and clean the dentures and your mouth twice a day. Always take your dentures out at night.

Voice problems after COVID-19

Talking can be more difficult if you are short of breath. Your voice might sound weak, quiet, rough or hoarse. Your speech may not be as clear as it used to be.

Voice problems (dysphonia) are common after COVID-19.

They often happen with other problems such as:

  • voice fatigue
  • cough
  • inflammation inside the nose (rhinitis)
  • shortness of breath
  • loss of appetite
  • sore throat

If you were in hospital and needed a breathing tube, this can affect your voice box or cause a sore throat.

Voice problems should improve as your symptoms get better.

Talk to your GP if you continue to have voice problems 2 weeks after you have recovered from COVID-19.

They can refer you to an SLT who can diagnose and treat voice problems. Your SLT may work with an ear, nose and throat (ENT) specialist to help you.

Looking after your voice

To help your voice recover, stay hydrated by drinking plenty of water.

Try to avoid:

  • shouting or forcing your voice out
  • clearing your throat too often - drink water or do one big cough instead
  • deliberately whispering - this does not 'save' your voice, it puts strain on the voice box
  • drinking a lot of caffeine or alcohol
  • smoking or vaping
  • medicated lozenges and gargles - the relief they provide may cause you to force your voice even more
  • hot or dry air
  • dusty environments

Speaking more clearly

To help people to hear you better, you can try:

  • sitting in an upright position and taking a breath before you talk
  • reducing the background noise when you talk with others
  • stopping, resting and trying later if your voice feels tired

If your voice is very hoarse or weak, avoid speaking during phone or video conversations. Try to use text-based options instead.