You need to manage your cough for 2 reasons:
- To minimise post-viral complications
- To minimise how swollen your vocal folds get. The more swollen they are and the longer the cough lasts means you-
a. are more likely to lose your voice and get laryngitis
b. 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:
- drinking a LOT of water
- steam inhalations
- saline nasal spray or nasal irrigation (eg nettipot)
To get your thinned phlegm out, try:
- gargling warm salt water will help shift pathogens and allergens from your throat and tonsils
- gentle SOVT exercises, particularly straw phonation (a great way to move that phlegm!)
- change the way you cough to recruit stronger air pressure and therefore reduce the repetition of the cough mechanics.
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!
- Sip water to help calm it down
- Suck on a lozenge (preferably UNmedicated so it doesn’t dry you out any further)
- Chewing gum – stimulation of saliva and frequent swallowing can help calm the impulse
- Breathing deeply – getting your focus to go lower than the cough. In through your nose like you’re smelling a flower and imagine the breath travelling lower than your lungs
- Straw bubbling or lip trills – can shift any tiny flecks of phlegm up and out or your larynx or throat because the bubbling generates similar airflow to a cough, hence carrying the mucus out on that current of breath
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.
THE RETURN TO SINGING
If you’re recovering from a cough and are working your way back in to singing:
- Check your hydration habits – how much water are you drinking?
- Are you steaming regularly? Every 2 hours is great. Once an hour you can alternate steaming and gargling
- Straw bubbling – therapeutic version. Less pressure. 2 straws or a really wide straw – have it towards the top of the water for less resistance –
a. Will boost the therapeutic benefit of bubbling
b. Reduce the swelling of the vocal folds – this is the key to getting back to that upper register
- 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.
- Book in a session with your vocal coach to get an objective evaluation of how you are tracking in your recovery.
- Read these relevant blogs:
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.
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 in 2021.
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Australian Voice Association webinar. Drugs in Voice. 27 October 2020
In-lesson conversation with Emily Mullamphy
LeBorgne, W.D. & Rosenberg, M. (2014). The Vocal Athlete. Plural Publishing, San Diego
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