Published: May 4, 2026

GLP-1 Receptor Agonists and Dysphonia

Asking about recent GLP-1RA initiation when evaluating new-onset hoarseness or chronic cough is a simple step that may improve recognition of clinical patterns.

Nancy Jiang, MD, on behalf of the Voice Committee

Shutterstock 2260014791GLP-1 receptor agonists (GLP-1RAs) are now part of routine clinical care. Known widely by brand names such as Ozempic®, Wegovy®, and Mounjaro®, these medications have expanded rapidly from subspecialty endocrinology clinics to everyday discourse among the general public. As often happens these days, patient-reported experiences have surfaced online before any disease-specific research has been conducted. Online forums and social media discussions describe hoarseness, throat discomfort, and intermittent voice loss after starting these medications, sometimes referred to as “Ozempic voice.”1-5

Given the recent surge in GLP-1RA use among our patients, these concerns will likely begin to appear in otolaryngology clinics. Because uptake of this medication has been so rapid and expansive, the research has not been able to keep pace. There remains a paucity of data on the full range of potential consequences of GLP-1RAs, particularly in the long term. This article will attempt to review whether there is a clinically meaningful association between GLP-1RA use and dysphonia and whether this is supported by existing literature.

GLP1-RA Mechanism of Action

GLP-1RAs mimic the endogenous hormone glucagon-like peptide-1. They enhance glucose-dependent insulin secretion, slow gastric emptying, and promote satiety. Initially approved for type 2 diabetes (exenatide in 2005), they are now widely prescribed for obesity management, with liraglutide approved for weight loss in 2014 and semaglutide in 2021.6-8 Utilization and spending have increased substantially in recent years.9

Their pharmacologic effects suggest several pathways relevant to otolaryngology and potential adverse effects on the voice. Delayed gastric emptying can exacerbate reflux symptoms.8,10 Substantial weight loss is common and is often accompanied by reductions in lean body mass.12, 20-21 These physiologic changes may theoretically contribute to dysphonia. It is reasonable to hypothesize that these medications could promote reflux-related laryngeal irritation, chronic cough, mucosal dryness, and vocal fold atrophy.

Otolaryngology-Specific Findings

Otolaryngology-focused analyses are beginning to appear in the literature. A 2025 study in Laryngoscope examined the FDA Adverse Event Reporting System (FAERS) for ENT-related events associated with exenatide, liraglutide, dulaglutide, semaglutide, and tirzepatide. Gastroesophageal reflux disease (GERD) was reported across agents.13 Dry mouth was more frequently reported with semaglutide, and dysphonia with liraglutide. While voluntary reporting data are inherently limited and susceptible to reporting bias, patterns in a large national database warrant awareness and attention to these symptoms.

Additional head and neck effects have been described outside the larynx. Otology literature has reported cases of patulous eustachian tube dysfunction following rapid GLP-1RA-associated weight loss.17-18 Although not directly related to voice, these reports reinforce a broader point: rapid changes in tissue composition may have consequences across the upper aerodigestive tract.

Gastrointestinal Adverse Effects and the Implications in Otolaryngology

Gastrointestinal adverse effects are the most frequently reported complications of GLP-1RAs.8,10,11 A 2025 systematic review and meta-analysis of placebo-controlled trials demonstrated an increased risk of GERD.11 Population-level data reinforce this finding. A 2025 cohort study comparing GLP-1RAs with SGLT-2 inhibitors (including empagliflozin and dapagliflozin) found that GLP-1RA users had both a higher risk of GERD and of GERD complications.15 A separate matched-cohort analysis reported that shorter-acting agents (such as exenatide twice daily or lixisenatide) were associated with more GERD-related complications than longer-acting medications (such as weekly semaglutide or dulaglutide).14

For otolaryngologists, these findings suggest that GLP-1RAs could also increase the risk of laryngopharyngeal reflux. With laryngopharyngeal reflux, laryngeal irritation and inflammation can present as hoarseness, throat clearing, globus, and/or cough. In this context, increased reflux symptoms offer one plausible explanation for hoarseness reported by some patients on GLP-1RAs.

Chronic Cough

Chronic cough may be another symptom associated with GLP-1RA use. In a large multicenter cohort study of adults with type 2 diabetes published in JAMA Otolaryngology–Head & Neck Surgery, GLP-1RA use was associated with an increased risk of incident chronic cough compared with several other second-line diabetes therapies.16 The association persisted after excluding patients with GERD, suggesting that reflux alone may not fully explain the finding. The authors discuss several possible mechanisms, including laryngopharyngeal reflux or microaspiration, vagal afferent stimulation, possible GLP-1 receptor expression in respiratory tissues, and xerostomia-related dryness, while emphasizing that further work is needed to confirm causality and define the underlying mechanism.

From a voice standpoint, a chronic cough can contribute to dysphonia and broader laryngeal dysfunction. Patients with chronic refractory cough often report impaired voice-related quality of life and may demonstrate laryngeal hyperfunction, supporting a role for maladaptive muscle tension and cough-related laryngeal irritation. Although chronic cough has also been associated with vocal fold lesions in some patients, the evidence suggests these lesions are uncommon and not a consistent finding.22-25

Weight Loss and Body Composition’s Impact on the Voice

Substantial weight reduction is often the intended therapeutic effect of GLP-1RAs. This change in body composition can, in turn, alter our respiratory tract and supraglottic resonance, which could affect the voice. A systematic review of voice outcomes after bariatric surgery with rapid weight loss found a trend toward improved vocal quality.19 The authors hypothesize these improvements may result from better pulmonary mechanics (less abdominal and mediastinal restriction leading to improved lung volumes and respiratory support) and reduced supralaryngeal and vocal tract adiposity, which may lower resistance and decrease the pressure required to initiate phonation, thereby improving respiratory/phonatory coordination.

On the flip side, GLP-1RAs are also associated with measurable reductions in lean body mass.20-21 Although the relative proportion of lean mass may remain stable, absolute muscle loss could theoretically affect respiratory support negatively or lead to vocal fold atrophy in susceptible individuals. This hypothesis remains untested but is biologically plausible.

Can GLP-1RAs Cause Hoarseness?

At present, the evidence supports biologic plausibility and provides a starting point for hypothesis generation. Most available data derive from administrative databases, pharmacovigilance reports, and retrospective cohorts rather than prospective, voice-focused studies. Dedicated investigations of dysphonia as a primary outcome do not currently exist.

Nonetheless, when new hoarseness develops after initiation or dose escalation of a GLP-1RA, several pathways merit consideration: reflux-related laryngeal irritation, chronic cough leading to laryngeal hyperfunction, mucosal dryness, and physiologic changes associated with rapid weight loss.

Practical Considerations

As GLP-1RA prescribing continues to expand, several practical steps may be useful in clinic:

  •  Include GLP-1RA use in the medication history when evaluating new dysphonia or chronic cough. Patients may not volunteer these medications unless asked directly.
  • Clarify timing. Symptom onset relative to medication initiation or dose escalation can be informative.
  • Screen for reflux and cough drivers, given documented increases in the risk of GERD and chronic cough.
  • Exercise caution before attributing dysphonia solely to GLP-1RA use and maintain a broad differential for hoarseness or voice changes.

Looking Ahead

ENT-specific research remains in its early stages. Large datasets provide important clues, but mechanistic data are sparse. Studies of GLP-1RA with dysphonia as the primary outcome are needed and should incorporate validated symptom instruments, objective acoustic and aerodynamic measures, laryngostroboscopy findings, and careful documentation of dosing and weight trajectories.

In the meantime, awareness is warranted. Asking about recent GLP-1RA initiation when evaluating new-onset hoarseness or chronic cough is a simple step that may improve recognition of clinical patterns. Careful documentation today will help determine whether the association ultimately reflects causation, susceptibility in specific subgroups, or coincidental overlap in a population increasingly exposed to these medications.

 

References

  1. Alessi Institute. What is Ozempic voice? Instagram. Published 2023. Accessed February 24, 2026. www.instagram.com/reel/CyeqyDwP2Ff/
  2. Reddit user. Ozempic and voice changes? Reddit. Published 2023. Accessed February 24, 2026. www.reddit.com/r/Ozempic/comments/13ox8ss/ozempic_and_voice_changes/
  3. Reddit user. Side effect: hoarse voice? Reddit. Published 2024. Accessed February 24, 2026. www.reddit.com/r/Semaglutide/comments/1jdujoc/side_effect_hoarse_voice/
  4. Drugs.com. Ozempic side effects to watch for. Accessed February 24, 2026. www.drugs.com/medical-answers/4-key-ozempic-side-effects-watch-3573389/
  5. Novo Nordisk. Possible side effects of Ozempic® (semaglutide) injection. Accessed February 24, 2026. www.ozempic.com/how-to-take/side-effects.html
  6. Celletti F, Farrar J, De Regil L. World Health Organization Guideline on the Use and Indications of Glucagon-Like Peptide-1 Therapies for the Treatment of Obesity in Adults. JAMA. 2026;335(5):434-438. doi:10.1001/jama.2025.24288
  7. Elmaleh-Sachs A, Schwartz JL, Bramante CT, et al. Obesity management in adults: a review. JAMA. 2023;330(20):2000-2015.
  8. Grunvald E, Shah R, Hernaez R, et al. AGA clinical practice guideline on pharmacological interventions for adults with obesity. Gastroenterology. 2022;163(5):1198-1225. doi:10.1053/j.gastro.2022.08.045
  9. Tsipas S, Khan T, Loustalot F, Myftari K, Wozniak G. Spending on glucagon-like peptide-1 receptor agonists among US adults. JAMA Netw Open. 2025;8(4):e252964. doi:10.1001/jamanetworkopen.2025.2964
  10. Yanovski SZ, Yanovski JA. Approach to obesity treatment in primary care: a review. JAMA Intern Med. 2024;184(6):818-829. doi:10.1001/jamainternmed.2023.8526
  11. Chiang CH, Jaroenlapnopparat A, Colak SC, et al. Glucagon-like peptide-1 receptor agonists and gastrointestinal adverse events: a systematic review and meta-analysis. Gastroenterology. 2025;169(6):1268-1281. doi:10.1053/j.gastro.2025.06.003
  12. Mozaffarian D, Agarwal M, Aggarwal M, et al. Nutritional priorities to support GLP-1 therapy for obesity: a joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society. Am J Clin Nutr. 2025;122(1):344-367.
  13. Khan FI, Vazquez SG, Mehdi Z, et al. Otolaryngologic side effects of GLP-1 receptor agonists. Laryngoscope. 2025;135(7):2291-2298. doi:10.1002/lary.32061
  14. Liu BD, Udemba SC, Liang K, et al. Shorter-acting glucagon-like peptide-1 receptor agonists are associated with increased development of gastro-oesophageal reflux disease and its complications in patients with type 2 diabetes mellitus: a population-level retrospective matched cohort study. Gut. 2024;73(2):246-254.
  15. Noh Y, Yin H, Yu OHY, Bitton A, Azoulay L. Glucagon-like peptide-1 receptor agonists and risk for gastroesophageal reflux disease in patients with type 2 diabetes: a population-based cohort study. Ann Intern Med. 2025;178(9):1268-1278. doi:10.7326/ANNALS-24-03420
  16. Gallagher TJ, Razura DE, Li A, Kim I, Vukkadala N, Barbu AM. Glucagon-like peptide-1 receptor agonists and chronic cough. JAMA Otolaryngol Head Neck Surg. 2026;152(2):163-171. doi:10.1001/jamaoto.2025.4181
  17. Sudhoff H. First report on a case series of patulous Eustachian tube following GLP-1 receptor agonist-induced weight loss. Eur Arch Otorhinolaryngol. 2025;282(12):6533-6538. doi:10.1007/s00405-025-09604-5
  18. Pak KY, Cutri RM, Nadeem W, Kothari D, Wong YT, Wu AW, Miller ME. GLP-1 receptor agonist induced Eustachian tube dysfunction: database and systematic review of otolaryngologic adverse events. Otol Neurotol. 2025;46(1):19-22. doi:10.1097/MAO.0000000000004373
  19. Talugula S, Mangahas A, Carlson A, Husain IA. Voice outcomes after bariatric surgery: a systematic review. J Voice. 2025;39(4):1140.e17-1140.e26. doi:10.1016/j.jvoice.2022.12.019
  20. Liu Z, Weeldreyer NR, Angadi SS. Incretin receptor agonism, fat-free mass, and cardiorespiratory fitness: a narrative review. J Clin Endocrinol Metab. 2025;110(10):2709-2717. doi:10.1210/clinem/dgaf335
  21. Karakasis P, Patoulias D, Fragakis N, Mantzoros CS. Effect of glucagon-like peptide-1 receptor agonists and co-agonists on body composition: systematic review and network meta-analysis. Metabolism. 2025;164:156113. doi:10.1016/j.metabol.2024.156113
  22. Adessa M, Xiao R, Hull D, et al. Benign vocal fold lesions in patients with chronic cough. Otolaryngol Head Neck Surg. 2020.
  23. Shaha M, Hoffman MR, Hapner ER, Simpson CB. Membranous vocal fold lesions in patients with chronic cough: a case series. J Voice. 2023.
  24. Razura DE, Gallagher TJ, Khachikyan N, Johns MM III, Shuman EA. Laryngeal sensory neuropathic cough is not associated with membranous vocal fold lesions. Laryngoscope. 2025;135(11):4296-4302.
  25. Vertigan AE, Kapela SM, Kearney EK, Gibson PG. Laryngeal dysfunction in cough hypersensitivity syndrome: a cross-sectional observational study. J Allergy Clin Immunol Pract. 2018;6(6):2087-2095.Cell
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