Ten Tips for Sick Singers

As singers we need to take extra care of our voices during these Winter months, as losing them can impact not only our hobbies, but also, for many of us, our livelihood.

So here’s an updated version of tips I've posted previously on my Facebook page to ensure you come out the other side of any sickness with the healthiest voice possible.

Bonus tip: cover your mouth when you cough or sneeze because ew

1. Go to the doctor

But take a book – you know how those waiting rooms can be.

2. Grab a straw

Semi-occluded vocal tract (SOVT) exercises have been shown to facilitate "quicker and better healing in the cells and tissues [of] the larynx and vocal folds" (Titze 2017). If that's a completely new term for you check out this video by Tom Burke:

However, in the case of vocal haemorrhage you'll be looking at "total voice rest for 2 weeks" (Titze 2017). If you're not sure and would like to confirm exactly what you're dealing with (recommended), refer to tips 1, 3, 5, 7, and 9.

If you do find yourself on vocal rest, invest in a mini whiteboard or some similar writing aid, although these days it’s just easier to just use the notes app on your phone. Alternative you can check out Zazzle.com for some helpful apparel.

For a comparison between resonant voice use and vocal rest click check out Resonant Voice Exercise is Better than Vocal Rest? (Knickerbocker 2017).

3. Go to the doctor

Have you booked yet? Go on.

4. Water, water, water

At least 2 litres a day.

Anything you drink doesn’t directly hydrate your vocal folds. Think about it – if you inhaled the fluids you drink you’d drown. That goes for water, tea, coffee, alcohol – none of them have a direct effect on your vocal folds.

Imbibed fluids have to be absorbed by the body before they can hydrate anything, and this can take anywhere from 2-24 hours.

I tell my students to hydrate today for tomorrow. That way you’re sure your body has absorbed all of the fluids you’ve given it, plus it prompts you to be hydrating every day.

5. Go to the doctor

Don’t like talking to strangers over the phone? I get it. Try downloading the handy HealthEngine app – it allows you to find and book local appointments without the discomfort of having to engage with an actual human being.

6. Lozenges are a BIG NO NO!

Local anaesthetics numb the throat.

If your throat is numb, you have to push harder to feel anything. Analgesics (Panadol, etc) are better as you still have sensation although they also thin the blood, increasing your chances of haemorrhage. Refer to tips 1, 3, 5, 7, and 9 if you're not sure but definitely NOT lozenges.

Similarly, be wary of decongestants. Yes they dry the mucus in your sinuses so you can breathe, but they also dry the lubricating mucus in your throat that your vocal folds need to function properly. They’re OK for overnight use if you need to sleep but be careful during the day. I personally prefer to just ‘glug’ through things if I get sick, rather than drying everything out – including the stuff I need.

To quote Tim Minchin, my “placebo of choice” when sick is good ol’ olive leaf extract and a vitamin C, zinc, and echinacea combination.

If things get chesty, refers to tips 1, 3, 5, 7, and 9, who will most likely prescribe you with some sort of suppressant (to stop the cough) and a mucolytic to thin the mucus, making it easier to bring up (apologies for the mental image). Mucolytics thin the mucus without drying it up, meaning the ‘good’ mucus in your throat is still present. But ultimately I’m no MD – check with your pharmacist (at least) before starting any treatments.

7. GO TO THE DOCTOR

Don’t have a car? NO EXCUSES

8. Steam / Nebulisation 

Remember: the ONLY WAY to DIRECTLY hydrate your vocal folds is via inhalation. Anything you swallow (such as teas) takes a different path (the oesophagus) whereas the larynx is part of your respiratory system that uses the trachea. (Smoke takes the same path, which is why it’s so bad for singer’s instruments. If you’re a singer and you’re still smoking, quit).

Therefore, your options to directly hydrate your folds are:

Option 1 - Steam

• Boil the kettle
• Pour the water into a bowl
• Leave to cool for 2-3 minutes
• Stick your head under a towel and breathe the steam for 10-15 minutes
• Repeat twice a day or to your liking.

Alternatively you can use hand-held options like the famous Bosisto's Steam Inhaler (found in every dressing room ever) or the Vicks version.

One argument against steaming asserts that steam droplet are too big to be absorbed by the vocal folds/there's a lower chance of them actually reaching the folds as they're more likely to get stuck on/absorbed by other parts of the vocal tract. That being said, I personally find steaming to be quite calming/soothing but each to their own. Whatever you do make sure the steam is not too hot as "forcing high heat air (steam) in without allowing for the body’s natural inclination to cool it to body temperature would exacerbate oedema (inflammation) – not useful!” (Gupta 2015).

Option 2 - Nebulisation

One solution to the larger droplets issue is nebulisation. Two studies by Kristine Tanner et al. found that "nebulized Isotonic Saline has the potential to reverse the perceived adverse effects associated with laryngeal dryness in singers, whereas nebulized sterile water was inadequate in addressing these effects" (2010), and "Nebulized isotonic saline improves voice production based on acoustic and patient-based ratings of voice severity" (2015).

The trick here is to use 0.9% isotonic saline: "The latest findings indicate that using a nebulizer with isotonic saline can reduce your Phonation Threshold Pressure (PTP) as well as your Perception of Phonatory Effort (PPE), meaning it takes less pressure for your vocal folds to create sound" (via VocalMist).

Now, there's a few options on the market. I was personally going to order the VocalMist (US$98 + US$15/month for 'refills') when I found the exact same (albeit it unbranded) unit on Wish for AU$60 (at time of purchase). Then I jumped on eBay for some saline and was good to go!

However, stats and quotes aside, internationally renowned otolaryngologist Dr Anthony F. Jahn cautions against the use of nebulisers “for maintenance", arguing that they should be used for "specific symptoms only and, ideally, with some input from a medical professional".

9. GO TO THE BLEEDIN’ DOCTOR ALREADY

If you’re still reading this and haven’t booked yet, I can’t help you. Maybe try WebMD? Although if you head down that path you’ll probably end up with a cancer diagnosis. At least that’s what it always tells me.

But seriously, if you do go you've got a better chance of finding out exactly what you're dealing with rather than trying everything/hoping/guessing and can therefore treat it directly/appropriately (and therefore hopefully more quickly).

10. Rest as much as you can and then start using your voice slowly and gently once it’s feeling better

Sometimes the recovery process can take as long as 4-6 weeks, especially if things progress as far as laryngitis/you end up losing your voice completely. Take care and don’t push things too quickly, even if your voice feels like it can – if you’re unsure, consult your vocal health specialist.

Happy, healthy singing 🙂