Why Zoom meetings and face masks may be causing more hoarseness and other voice issues

Life during the COVID-19 pandemic may be contributing to an unexpected health issue: voice problems.

Voice experts at the University of Chicago Medicine’s Voice Center are seeing more patients with functional voice problems, which may be related to changes in the way they use their voices while talking on Zoom, wearing masks and social distancing. In patients with existing voice problems, added vocal tension (also referred to as muscle tension dysphonia) in the larynx can cause a hoarse voice, and occasionally even throat pain or other issues.

They can be contributing factors for teachers and others whose jobs require them to talk all day, and for healthcare professionals who must wear thicker N95 masks.

“It’s not just one thing that causes a voice problem,” said UChicago Medicine speech-language pathologist Sweta Soni, MA, CCC/SLP. “It’s usually a mixture of things, and masks and video calls are likely contributing factors.”

UChicago Medicine laryngeal surgeon Brandon Baird, MD, director of the Voice Center, notes that some of the increased tension may be related to increasing vocal effort because of inconsistent quality of teleconferencing microphones and speakers. It can cause people to overcompensate with their voice, and speak louder than normal.

“We are seeing more patients who have a lot of Zoom commitments — especially those with known underlying muscle strain — come in with an exacerbation of their existing issues, or issues that they didn’t have before,” Baird said. “Additionally, we are seeing more people who have to push extra hard to be heard because the mask is muffling them.”

Masks eliminate the visual cues people typically get from mouth movement. People might raise their voices thinking it’s necessary for others to hear them, especially when they’re standing farther away than normal due to social distancing. While these COVID-19 safety measures are essential, they might require patients with preexisting voice problems to take extra precautions.

“Stress can impact voice, too. So all of the stress surrounding the pandemic may cause people to tighten the muscles of their throat when they speak, which may further enhance problems related to their voice,” Soni said.

Optimizing vocal health and hygiene may help users meet their vocal demands more easily. Baird and Soni suggest staying hydrated to reduce throat irritation, and taking short breaks between meetings may be helpful.

Also, people should pay attention to how they’re using their voice, and try to speak at a comfortable volume.

“There are ways to fix a lot of voice problems, so don’t get discouraged,” Baird said.

At what point should someone see a doctor? If their voice is persistently scratchy, strained or hoarse or if they’re feeling lasting discomfort or pain.

Treatments, plus a full line of voice services, are available at UChicago Medicine’s Voice Center. The center is staffed by specialists in areas such as laryngology, neurological voice disorders, muscle tension vocal problems, chronic coughing and swallowing disorders.

The Voice Center's unique comprehensive approach to care allows the patient to meet with both the physician and speech therapist during the same visit, reducing the total number of appointments.

“It streamlines the process. We work as a team to evaluate the various factors that can be contributing to the voice problem, discuss the findings with the patient, and determine a personalized treatment plan,” Soni said.