Coughing Vs Singing

There is a silent battle going on in each of us.  The battle between our muscle memory and our conscious, discerning choices.  This battle exists in thousands of areas of our lives – such as confirmation or unconscious biases, nutritional habits or speech patterns.

This is largely to do with the brain’s love of recognising and forming patterns.  Which is great…until that pattern becomes the path of least resistance, and we require more from the brain to create a new and better pattern instead of settling for what is familiar and comfortable.

Today we’re looking at how that silent battle sets up a competition between our body’s autopilot cough reflex and our singer’s intention to prioritise vocal fold health and flexibility.

FIT TO SING

Straight up, I want to propose that you take a new approach to illness.  Unlike other instrumentalists, you never pack your instrument away.  It is always with you.  It is exposed to everything you inhale and ingest.  It rides every wave of emotional, hormonal, psychosocial and biochemical change.  You are never not a singer!

Therefore, I believe that you need to do what is in your power to minimise the influence of illness and medication on your voice.

Now – I did say what is in your power.  And that is a very important caveat.  There will be a lot of times in your life when the best course of treatment to preserve your existence may not be what is optimal for your voice.  Guess what?  Saving your life trumps singing (to be fair, I think Dr Dan said that!).

Therefore, what I’m talking about here is the stuff you CAN control.  The minor health conditions that roll our way seasonally fit into this category and are the focus here.


“Our philosophy with any of the players here at the WACA is you need to be fit to perform rather than fit to play.”

Justin Langer, Australian cricket coach and retired player


Langer made this statement concerning a Western Australian player, Jason Behrendorff, who was returning to training following a stress fracture in his back.  And the statement struck me as something that singers could relate to a lot.  Jason was fit to train, but he needed time in the nets to establish he was fit to perform.

Because performance necessitates a degree of adaptability, cognitive focus and physical resilience, being “just well enough” to train or play the game isn’t enough.  Fitness to play is the minimum requirement.  The parallels to singing are obvious.  You may be fit enough to practice, maybe even to rehearse – but are you fit to run the full gamut of pre-show routine, plus show delivery, plus post-show foyer time and self-care engagement?


“Anyone whose livelihood depends on their vocal quality becomes at least a little anxious at the threat of infection to their respiratory tract.  Although well-trained actors and singers will frequently be able to perform whilst suffering from a cold, the full glory of their voice is unlikely to be heard.  Singers have to work far harder than usual to sing on top of a cold whilst ensuring that their audience doesn’t feel short-changed.”

Pat Wilson


My working hypothesis is that the way you manage an upper respiratory tract impairment, like a head cold, chest infection, allergy or influenza will determine how fit your voice is when you recover and return to singing.  And not just that base-line fitness, but your full vocal range, resonant capacity, technical stamina and performance energy.

Particularly, as indicated by the title Coughing Vs Singing, the way you manage your coughing while you are unwell will directly impact how long it takes you to return to performance fitness…not just training fitness.

You might be thinking “but I can’t control my urge to cough”!!!  Well…I think you can.  Most of the time.  But not all the time.  I have only had pneumonia once in my life…but that was definitely a game-changer.  All bets were off and singing rehab was going to look very different.  And so, I had to change my teaching and performance commitments to allow for proper recovery and rehabilitation (which ended up being somewhere in the vicinity of 6-10 weeks).

So…this advice is going to be for your (mostly) garden-variety seasonal viruses and allergies.  For the times when a cold or reaction is just starting to take hold and you can make early choices about how you will rest and treat it.

COUGH BEGETS COUGH

This is a phrase frequently used by laryngologists and speech pathologists.  I first heard it during a fascinating webinar about the voice and drugs (medicinal and recreational) with Australian ENT surgeons Dr Georgina Harris & Dr Paul Paddle.  It simply means that the more you cough, the more you will cough.  In their words, “the more you cough, the more cough receptors in your throat and brain are activated.”

I recommend that you start managing your cough response in such a way that the subconscious muscle memory habit doesn’t take hold or become overactive.

It is worth mentioning here that throat-clearing falls into this category too.  In fact, throat clearing is more violent and damaging to the voice as it recruits a much higher rate of collision forces and rarely produces phlegm after one attempt.  It is more likely to move the irritant laterally around the throat or larynx, rather than propel it up and out like a cough does.

Throat-clearing is frequently triggered by post-nasal drip, particularly from allergies.  You might want to read more about that if this is an area you struggle with.  Managing illnesses like allergies is vital for all singers, whether professional or singing for leisure.


TOP TIP

If you are struggling with vocal hoarseness, a lack of vocal flexibility or localised throat discomfort…ask yourself this question:

“How many times did I cough or clear my throat in the last hour?

How about in the last five minutes?”

If you can’t answer that question, then the first step to take is to find a way to increase your conscious awareness of each cough or clear.

This self-awareness is critical to being able to intentionally try another strategy before you CHOOSE to cough.


COUGHS AREN’T ALL BAD

Honestly…I’m not saying you should never cough.  The body is designed to use this mechanical process to “produce” the thicker, sometimes infected, phlegm in your lungs.  It is also a VITAL response to save your life when something “goes down the wrong way” – when the epiglottis misbehaves and matter heads through the larynx toward the trachea instead of toward the oesophagus.

But how often have you had a lingering dry cough for weeks after the “productive” wet cough went away?  And how often has that dry cough co-existed with a frustration reduction of your singing range and vitality?

HOW A COUGH WORKS – A LITTLE ANATOMY

“A sequence of events is initiated by the sensitivity of the lining of the passageways of the lung,

mediated by the medulla as a consequence of impulses transmitted by the ages nerve.”

Ingo Titze


“Coughing is a reflex action designed to clear your larger breathing passages of

excess secretions, irritants and any bits and pieces that your body doesn’t want in your lungs.”

Pat Wilson


The vocal folds can move in two distinct ways – and unpacking these behaviours goes a long way to understanding your voice.  Appreciating that making sound is their second priority is crucial in your overall vocal health management plan.

  1. Opening/closing
    1. to protect the airway from inhaling substances that will damage the lungs and lead to death
    2. to assist in bearing weight – for lifting, bowel motions and giving birth
  2. Valving
    1. to ripple wave along their length and mass to phonate, permitting the creation of language and music

So, if the major job of the vocal folds is to protect and clear the airway, it is no wonder that they initiate coughing behaviour unconsciously to help you out when your health is compromised by excess or thickened mucus.

That is why they bang together when you cough – they’re part of the process of clearing your airway and getting the phlegm out.  However, that violent banging of the vocal folds will produce what is known as phonotrauma – a change in vocal fold vibration from voluntary or involuntary vocal behaviour that impacts on sound and function.

There are two ways to stimulate a cough:

  1. Body – throat or lungs send a message through the nervous system to the brain flagging an irritation or breathing difficulty
  2. Brain – sends a message to the upper respiratory tract to setup the cough mechanism in order to clear the phlegm

Sometimes when you’re progressing to a recovery stage from a virus and you no longer have thickened phlegm, the cough transitions to being behavioural – the brain stimulus to cough has been so intensely triggered that it is overactive.  Such a cough tends to be dry and unproductive, i.e. the cough no longer has a purpose. A doctor might diagnose this as a post-viral cough, although this is not exclusively behavioural.

HOW TO MANAGE YOUR COUGH

You need to manage your cough for 2 reasons:

  1. To minimise post-viral complications
  2. To minimise how swollen your vocal folds get. The more swollen they are and the longer the cough lasts means you-
    1. are more likely to lose your voice and get laryngitis
    2. will take longer to get your full range back after you recover, particularly in the upper pitch range

There are times when coughing is essential, but the more you can thin the phlegm and have other ways of getting it out, the lower the chance that phonotrauma will result.

To thin your phlegm, try:

To get your thinned phlegm out, try:

Your major job is to move the thick phlegm up and out of your lungs.  But remember – phlegm isn’t bad!  It is evidence of your immune system at work. We don’t want to deny your body this – it has to come out!  We just want to get it out in a way that minimises the long term set back of your voice.  Then you will be fit for play AND performance as soon as possible.

So…what to do when you are triggered to cough – the tickle impulse arrives and your body just HAS TO DO something!

Be aware that if you suffer from reflux, prolonged periods of coughing are likely to worsen your symptoms and a temporary adjustment to your medication might be in order.  If this occurs, I recommend a visit to your GP to discuss a strategy that will work for you.  This might be an area you can incorporate into your personal vocal health plan.

MEDICATIONS FOR COUGHS

Bear in mind the impact of medications on your voice.  Many cough, cold and allergy remedies are far too dehydrating for this balancing act between voice and cough mechanism.  (This includes antihistamines, anything containing menthol and brands like Codral.)  The dryer your soft tissue becomes, the more thick phlegm your body will generate to solve the problem, and the more your cough can be triggered.  Drs Harris and Paddle described the lack of evidence of some liquid cough medicines and exporants for having efficacy as a treatment.  Their best advice is to thin the mucus by drawing water into it.

If these natural and early interventions don’t work, talk with your pharmacist or GP for the best voice-friendly strategy.  And if stronger medications than paracetomol are called for, you will do well to take a break from singing so that you don’t exacerbate the vocal compromise.

ANECDOTE

A quick example that I worked through earlier this year.  I was attending a performance of Jersey Boys and was seated in the 2nd or 3rd row, toward the middle.  During the second act, in the most affecting  ballad of the whole show, as Franki Valli started singing about his daughter’s passing, an irrepressible cough urge overcame me.

We’ve all been there, right?  My entire universe shrank to the priority of getting it under control noiselessly.  I missed every moment of that scene and could only think…why on earth didn’t this happen during the louder numbers…of which there were a LOT in this show!

I started trying to build up saliva and swallow repeatedly while my hand groped around in the dark for my handbag.  Where I always keep some old school honey and eucalyptus drops.  Except I had brought a different handbag.  And not transferred the little jewels of solace I now sought.

My hand fell on my drink bottle with its built-in straw and in desperation, I sat for the rest of the song sipping and swallowing like a mad woman until the audience broke into rapturous applause and I could do one or two decent coughs to shift the irritation.  That persistent and focussed sipping and swallowing, combined with deep breathing to calm myself down, did the trick.  I had to be utterly mindful about it and ignore the poignant scene on stage.  But it saved me from having to clamber out of the theatre and ruin it for everyone around me.

THE RETURN TO SINGING

If you’re recovering from a cough and are working your way back in to singing:

  1. Check your hydration habits – how much water are you drinking?
  2. Are you steaming regularly? Every 2 hours is great. Once an hour you can alternate steaming and gargling
  3. Straw bubbling – therapeutic version. Less pressure. 2 straws or a really wide straw – have it towards the top of the water for less resistance –
    1. Will boost the therapeutic benefit of bubbling
    2. reduce the swelling of the vocal folds – this is the key to getting back to that upper register
  4. Choose gentle melodies, vocalises, songs and expectations to resume your practice. Avoid over-long sessions as you resume and gradually build your workload and length of practices back up.  Finish your session before you fatigue, and steam to cool down.
  5. Book in a session with your vocal coach to get an objective evaluation of how you are tracking in your recovery.
  6. Read these relevant blogs:
    1. Mucus Matters (includes a link to lists of medicines and their impact on the voice)
    2. When Am I Too Sick To Sing
    3. Why Does Water Matter?
    4. Singing with Allergies

Don’t push yourself or your higher range into action.  It will be possible to muscle your way to a sound, but that doesn’t mean that it’s safe to do so.

The safest way is to check the swelling is to intentionally lengthen the vocal folds by singing high and soft so that you can test how swollen they are.  Try this with singing something simple like ‘Happy Birthday’ in the upper half of your range.

More information on assessing your readiness to sing is available in the blogs listed above.

Do this test every day – how is it going? Is it improving and returning? Don’t force it! Wait until you can do it SOFTLY.

How long will it be until you see improvement?  Obviously, without knowing your particular circumstances, I can’t answer that.  But be prepared to care for yourself intentionally and consistently for potentially 1-4 weeks.  This time range will be affected by how much coughing you continue to do and how much phonotrauma is present.

FINAL THOUGHTS

There is no need to be afraid of coughing and its consequences.  Draw encouragement from the fact that this area of vocal health challenge is common, well-documented and researched.  I recommend that you seek advice from reliable sources and avoid trying random therapies and cures that can’t be substantiated.  Advice from fellow performers can be informative, but always verify it before you try it.

The most important thing is that you try not to let a cough get away from you.  Treat it early and intentionally.  Ask for help and don’t ignore it or assume it will just go away.

If you are a vocal coach or singing teacher, I urge you to complete training such as the Vocal Health First Aid course offered by Vocal Health Education.  On top of my vocal pedagogy training, this course was a fabulous investment and I’ve been exceptionally glad I completed it earlier this year.


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SOURCES

Australian Voice Association webinar.  Drugs in Voice.  27 October 2020

Cameron, Louis https://www.cricket.com.au/news/jason-behrendorff-fast-bowling-injured-list-western-australia-sheffield-shield-back-soreness/2017-11-13

In-lesson conversation with Emily Mullamphy

LeBorgne, W.D. & Rosenberg, M. (2014). The Vocal Athlete. Plural Publishing, San Diego

Photo by GR Stocks on Unsplash

Titze, I. R. & Verdolini-Abbott, K.  (2012).  Vocology: The Science and Practice of Voice Habilitation.  National Center for Voice & Speech, Utah.

Wilson, P.H. (2010). The Singing Voice: An Owner’s Manual (2nd Ed.). Lazy O’Rhinus Press, Sydney

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