The findings suggest voice and speech abnormalities may be an underrecognized aspect of the disease.
An online mixed-methods survey gathered responses from 685 individuals diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or long COVID with post-exertional malaise (PEM). Of these, 302 participants completed a qualitative section. Researchers analyzed open-ended responses for the terms “speech,” “voice,” “words,” and “speak.” Responses referring to cognitive difficulties, general communication, or speech therapy were excluded. Of 143 total keyword mentions, 105 were excluded, leaving 38 direct references to voice or speech dysfunctionin 28 unique responses, accounting for 9.27% of the qualitative sample.
Participants described symptoms such as slurred or sluggish speech, hoarseness, loss of speech, and difficulty articulating words or speaking more than a few sentences. These symptoms were reported without specific prompts, emerging spontaneously during responses to questions about activity management and pacing.
Respondents ranged in age from 18 to 80 years, with a mean and median age of 47 years. A total of 542 participants identified as female, and 411 indicated they were disabled or unable to work. The majority of respondents (640 of 685) identified as Caucasian.
While voice and speech issues are documented in other neurologic and inflammatory disorders—such as Parkinson disease, multiple sclerosis, and autoimmune myopathies—these symptoms have not been formally studied in ME/CFS. The spontaneous emergence of these symptoms in the current study raises questions about their prevalence and clinical significance in this population.
Stephanie L. Grach of the Division of General Internal Medicine at Mayo Clinic, and one of the authors of the study, wrote: “These reports emerged without direct prompting, meaning they were not asked to discuss voice and speech directly.” She added that this may indicate “that voice and speech alterations may be a meaningful yet underrecognized component of ME/CFS.”
The variability in how participants described symptoms prevented further categorization into specific speech dysfunction types such as articulation, phonation, or fluency. For example, the phrase “unable to speak” was used to describe both reduced vocal volume and articulation difficulty. This variability underscores the need for structured tools to assess speech and voice changes in ME/CFS.
Preliminary findings from studies in related conditions have shown potential benefits of vocal therapies. In a small pilot study, individuals with long COVID who participated in a 10-week vocal retraining program experienced improvement in breathing and overall well-being, and 14.3% no longer met criteria for ME/CFS post-intervention.
Artificial intelligence voice analysis is also gaining attention as a noninvasive diagnostic tool across multiple diseases. Given the potential role of dysautonomia and neuroinflammation in ME/CFS, voice-based biomarkers could support disease monitoring and evaluation in the future.
Limitations of the study include the lack of diagnostic verification, absence of a control group, and partial completion of the qualitative section. Despite these, the unprompted emergence of speech and voice symptoms suggests a potentially underappreciated feature of ME/CFS warranting further investigation.
The authors reported no conflicts of interest.
Source: Journal of Clinical Medicine
