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Mix Margaret Dylan Jones

W.A. composer, pianist, teacher, article writer

Specialist in solving singing problems

for a wide range of musical styles


Voice Article



Singer's Cough: Causes and Cures
For Vocal Inflammation And Excess Mucus
(Singing And Speech)


Article by Margaret Dylan Jones
Updated 11 July 2014

There are a lot of strange ideas out there about singing and speech, and they pre-date the internet by hundreds of years.

A persistent 'red herring' is that excess mucus is due to diet. That’s possible but not likely. Most commonly excess mucus (a productive cough) is caused by infection, dry air, lack of hydration (lack of water), or vocal fold inflammation (which itself has numerous causes). Taking herbal remedies and altering your diet may help initially, but in many cases they won’t address the underlying cause.

Immediate relief
If you need a quick fix I recommend the throat spray Benzydamine (sold in some countries as Difflam). It’s a locally-acting nonsteroidal anti-inflammatory  which also has local anaesthetic and analgesic properties. Reducing inflammation is generally a good idea in many situations as inflammation in its own right can prolong an illness or make it more severe. Diflam is virtually free of side-effects. I’ve used it for many years.

WHAT ARE THE CAUSES OF SINGER'S COUGH?

Infections

Vocal folds can become inflamed directly by infection, or indirectly by coughing off excessive phlegm produced during infection. An early warning sign of a throat infection is thicker saliva.

Dry air & lack of water
Dry air, and especially cold dry air, causes the mucus flowing upwards through the trachea to dry out, become thicker, and flow more slowly. When the mucus eventually reaches the vocal folds in the larynx it causes you to cough by reflex in an attempt to clear the folds. If you jog for exercise, the rapid breathing also increases the drying effect, compounding the problem. Because the flow has been slowed, and the impact of every step in jogging may cause the mucus to fall down or stay down in the trachea longer, there may be no noticeable coughing effect until some time after the exposure to the dry air. 

Poor hydration (from consuming diuretics such as caffeine or alcohol or simply not drinking enough water), and exposure to some types of air conditioning  where water is removed from the air, can cause similar effects. The mucus becomes drier and thicker.

The vicious cycle of coughing & irritation
If your vocal folds (vocal cords) become inflamed more mucus will be produced to help protect them. Unfortunately, this can work against you if it causes you to cough even more, thus increasing or prolonging the inflammation. That’s because when you cough or clear your throat you hold your vocal folds very tightly together and force compressed air between them. Being held together with such force makes them hotter and more irritated, and when the air breaks through there is friction with the air. Because of the high tension and the high air pressure the folds then come back together and collide at great speed, causing even more irritation. This sets up a vicious cycle: the folds are a little inflamed, you cough, they become more inflamed, so you cough again and so on. You are more likely to have this problem if you habitually cough or clear your throat even when there is no mucus there (called an ‘unproductive cough’). This can lead to the development of nodules, one on each fold at the point where they first collide, especially if there are other factors present such as poor singing or speaking technique.

Reflux
Acid (hydrogen chloride) coming up from your stomach can easily get onto your folds, especially if you are lying down, and we all lie down to sleep.

A typical scenario: Late at night a singer finishes their opera, music theatre show, rock gig, or karaoke bar, and picks up some take-away curry on the way home. In their sleep they get reflux and don't even know it. The next morning their voice is flemmy because of the acid burn.

How and what you eat or drink can have a major influence on your stomach's acidity, as can emotional stress and the 'fight or flight' reflex (where acid is quickly pumped into the stomach).

Reflux during the day can be triggered by drinking milk drinks on an empty stomach. The milk contains protein and fat but is a drink, not solid food. This fools your stomach into 'thinking' you've just had a big meal of protein, such as a steak. The stomach responds by secreting a lot of acid to aid in the digestion of a lot of protein, but you haven't had a steak and there is not a lot of protein. Hence, too much acid is produced and about ten minutes after drinking the milk you have acid coming up.

WHAT CAN YOU DO ABOUT IT?

Avoid cold drinks, caffeine & alcohol
Drink room-temperature water because it gives off more water vapour which helps keep your folds lubricated, whereas cold water tightens your muscles. It probably gets digested quicker, too. Some say hot drinks may loosen the muscles too much but I have not found this to be a problem.

Keep away from caffeine because it's a diuretic. That is, it causes you to urinate and dehydrate, as does alcohol. Alcohol wrecks the co-ordination of the muscles and also knocks-out the proprioceptors in the trachea which you use to adjust your breath pressure. Ever wondered why drunk singers sound drunk? Now you know.

Some singers just have to have a tipple before they go on stage. It helps them relax both mentally and physically. I've never done it, but then I don't drink alcohol anyway. If you must drink, keep it small.

Try to resist the coughing reflex as long as you can
This will cause a greater amount of mucus to build up on the folds so when you finally do cough you will use much less force to clear it off. Don’t worry if this means you’re talking or speaking with a very strange sound, unless you’re actually performing. If you have an audience you’ll have to clear your throat because they didn’t pay to hear your phlegm!

Avoid throat lozenges
Some have an anaesthetic, some have antibacterial properties, but ALL work by drying out your mucus membranes and that is death to your voice. Anything with eucalyptus oil, menthol, camphor oil etc will be drying.

Use ordinary or boiled lollies
They make you salivate. These lollies can really make a big difference. What a pleasant medicine!

Breathe through the nose
Inhale through the nose whenever possible in singing, speaking or even when silent. It warms and moistens the air.

Don't whisper
Whispering when your folds are inflamed will prolong the problem. If possible, try to speak at a normal volume or perhaps even a little louder than normal. It's all to do with how the airflow is used in good speech, and that may or may not be something you can do properly just from reading about it. When you inhale, take enough air to say what you're going to say, then just let it all out as you speak. If you get this right you will most likely find the pain of your inflamed vocal folds is not as great. Your folds like it when you use the breath correctly.

Use a vaporiser

You can get a vaporiser from a pharmacy, or put a bowl of water on top of an oil heater or infront of an air heater (just be careful about getting electrocuted from the water being spilt). You can even inhale steam from a kettle (but don’t get too close or it will be too hot and you could be seriously injured).

A vaporiser will help your ticklish throat and will also help to clear the eustachian tubes which run from inside your ears to the back of the throat. Avoid eucalyptus oil additives--they may be good for clearing your blocked nose but they work by drying out your mucus membranes and that is a major problem for the voice. Of course, you're not likely to be using your voice in your sleep so the eucalyptus may be OK overnight. Just be aware that in the morning you may have thick, dry mucus coming up from your lungs for a while so try not to cough it off too frequently.

Remedies for an acid stomach
Quick fix: use an antacid, especially one that seals the top of your stomach to prevent reflux in your sleep. But look into how and when you eat, and especially food combining to give yourself better stomach function and digestion so you don't get excessive hydrochloric acid.

Many other factors
This article deals with some common issues for coughing and excessive mucus in the singing and speaking voice. A cough, whether productive or dry, can be both a symptom and a cause of vocal fold inflammation and the situation may be compounded by faulty singing or speaking technique and a great many other factors.

Therefore, if your problem is on-going it is best to see someone knowledgeable in all these areas, such as the rare singing teacher who has a depth of understanding of vocal health, the rare speech pathologist who has specialised in this area (most don't), or an ENT (Ear, Nose & Throat) specialist medical doctor who deals with these kinds of cases. If you're in Perth, give me a call or send me an email

See my other articles:

How I handle throat infections, colds & flus


Checklist for how I handle throat infections, colds & flus

My mobile is 0414 374 701.

Margaret Dylan Jones, MusB(UWA), DipEd, LTCL, ATCL, AMusTCL, AMusA, is a composer, piano accompanist and voice teacher, whose first non-musical(?) hobby was examining old pianos at auctions with a torchlight and a tuning fork.

(C) 2010 and 2012 Mix M D Jones.
http://mixmargaret.com

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