Voice volume issues post ICU

[Lucindar]

Hello!

I was in ICU in February. I thought I just had a bad cough… I’d lost my voice and thrown up and felt shocking and my GP told me it was viral and to take aspirin. Two days later, I was blue-lighted to hospital with Flu, severe pneumonia, strep A and sepsis. I went into septic shock and was put into a coma for 9 days. I know I’m very lucky that I had a relatively speedy recovery- I was out of ICU altogether by day 14. The biggest problem that remains for me is that nearly 4 months later, I don’t have my normal voice back. Everyone on the ICU thought it was the common side effect of having a ventilator, but that clearly wasn’t the case for me! I’ve seen ENT and they have diagnosed me with silent reflux an and that has swollen my food pipe and irritated my vocal cords. I’m on week 5 of treatment and my voice is SO much better, but still croaky and limited in volume. I’m a teacher, so although I feel able in every other aspect, I can’t return to work. It is believed I now have this silent reflux courtesy of all the induced-coma-tubes. Wondering if anyone else has had this problem? If so, how long did it take for you to get your voice back and do you have any top tips to help speed the process up?

Thanks in advance!

Lucy x

[Sepsur]

I now have a hiatus hernia after ICU so took meds for that for a time. To regain strength of voice I had to regain core strength and strengthen my diaphragm - box breathing, yoga & Pilates will help all this. Check out cc-sn.org who run online sessions specifically for us.

[Rdance]

I saw a speech and language therapist who gave me some exercises. Can only remember 2 - singing and reading to my little girl doing the different voices. But they made it clear not to push my voice. Not sure mine was the same cause as yours exactly though so see if you can see an SLT.

[BigH63]

Hi Yes it is a common side affect, I ended up with voice changes still not back to normal but it’s a lot better. Also swallowing issues from breathing tube which I saw SALT team. Have to drink lots of water with every bit of food I have now. Good luck

[Myfanwy58]

Morning, Lucinda. I was intubated x3 whilst in ICU with a Covid pneumonia four years ago I could only speak in a whisper upon returning home and had a problem with feeling something sticking in my throat, excessive mucous etc. Over several months post-discharge I had to seek help from physios, speech therapists, and even a private appointment with an ENT consultant as the waiting list was excessively long on NHS. Endoscopy, bloods, X-rays, scans etc thankfully ruled out any sinister reason for the problem but the endoscopy did show that there’d been some vocal cord damage (probably caused by the repeat intubations) and there was a noticeable paralysis of one of the cords. Fast forward four years. The paralysis has rectified itself, the cord now working quite well even if slightly sluggish. I still have excessive mucous, oft feeling a need to clear my throat. I also suffer with acid reflux (never did before my Covid/ICU experience) and this too can affect voice quality. I take antacids on a regular basis and avoid mucous & acid producing food and drink. Dairy products & fats are particular triggers for worsening symptoms. It’s now become clear though that my voice has permanently changed. It’s rougher, raspier, weaker in volume, less range, more difficult to project, and requires effort when in a noisy environment. It’s frustrating, but I’ve finally come to accept it’s probably now as good as it’s ever going to be. Breathing excercises provided by physio & speech therapist were of some use, and understanding the effect of breathing on voice was particularly helpful. So easy to fall into ineffective, problem breathing, particularly after suffering a severe respiratory illness & a spell in ICU. Wishing you well in your continuing recovery… 🍃

[Lucindar in reply to Myfanwy58]

Oh my gosh Myfanwy! What a journey!! I’m wondering if you can remember where you were at vocally around 4 months after your discharge? Just so I can compare. Although, I’ve had an endoscopy and they told me my vocal cords were ok 🤞🏻 Just my career depends on my voice 😅😅

[Myfanwy58 in reply to Lucindar]

Hi Lucindar. Firstly, good to know you’ve had an endoscopy that confirms no vocal cord damage/trauma. That’s one thing out of the way! In reply to your question, at 4 months post-hospital discharge I was definitely still experiencing considerable voice problems and remained under the care of physio, speech therapist and ENT dr re same. There had been a slight improvement in strength, projection and range but it was nowhere near my previous norm. Some 4 years later it still isn’t. I must say though that at 4 months post ICU I was still very much in the early stages of vocal recovery, a further slow but steady improvement noticeable over the following year or so. I would think that’s quite possibly the trajectory for many folk. Like you and your profession, as nurse/counsellor my voice was so important to me. During the Covid pandemic it was needed even more than usual, particularly as so much work had to be carried out over phone and video link requiring much more effort than direct face to face communication. I found this very difficult and voice fatigue was a significant issue for at least a year or so. It was during this period that I found the help of physio and speech therapist to be of benefit, particularly around breathing and the effects of this on voice. I became aware of bad respiratory habits developing and had to unlearn same. This is where physio and speech therapist came into their own. So, 4 months into your recovery? I think it’s likely early days. Here’s to continuing improvement 🤞