Persistent Vocal Alterations and Throat Clearing in Professional Singers Following COVID-19 Infection: A...

Professional singers represent a uniquely vulnerable population whose livelihoods depend on optimal vocal function, yet the specific impact of COVID-19 infection on their voice health remains insufficiently characterized. We conducted a cross-sectional observational study through an anonymous online survey distributed via Wenjuanxing among professional singers in mainland China between January and June 2025. A total of 154 participants (mean age 35.8 years, 59.2% female) with at least 2 years of professional singing experience and confirmed COVID-19 infection completed a structured questionnaire that collected demographic information, infection details, self-reported vocal symptoms, and standardized voice handicap assessments using the Mandarin Chinese version of the Voice Handicap Index-10 (VHI-10). Statistical associations were analyzed using prevalence ratios with 95% confidence intervals calculated via generalized linear models. Vocal alterations were reported by 62% of singers during the acute phase and by 53% after recovery, while new-onset throat clearing emerged in 44% of participants exclusively in the postinfection period. Self-perceived voice impairment was present in 65.6% of participants, with a mean VHI-10 score of 14.8 (SD = 7.2). COVID-19 infection was significantly associated with vocal impairment (prevalence ratio = 2.33, 95% CI: 1.04-5.46, P = 0.03) and throat clearing (prevalence ratio = 9.13, 95% CI: 2.47-64.42, P = 0.001). After adjustment for age, gender, and years of professional experience, these associations remained clinically meaningful at 2.29 and 8.97, respectively. Correlation analysis revealed strong positive relationships between symptom severity and VHI-10 scores (r = 0.68 for voice impairment, r = 0.74 for throat clearing). Our findings demonstrate that COVID-19 infection more than doubles the risk of voice impairment and increases the likelihood of new-onset throat clearing nearly ninefold among professional singers. This study provides novel evidence from a Chinese cohort, highlighting the critical need for targeted voice care protocols and routine postinfection voice assessment in this high-demand occupational group.