It’s a few days before your performance, and you’ve been rehearsing for weeks or even months for this. All of a sudden you feel a slight tickle in your throat, and the feeling of dread that accompanies it – am I coming down with something? Singers are extremely aware of even the slightest change in their voice, but a bout of a common cold (viral upper respiratory infection) might cause such drastic change that everyone could notice that you’re hoarse. Your mind starts racing – What do I do? Is it going to get worse? Do I need to cancel? Can they find someone else? Am I going to burn bridges?
While the average person is affected to some degree by the common cold and nobody likes it, professional voice users, especially singers, can be profoundly affected during the course of one.
Respiratory infections in general can affect the voice in three major ways:
- They can affect the vocal cords directly – acute viral laryngitis (commonly known as simply “laryngitis”) can cause severe hoarseness or even completely loss of voice by causing swelling of the vocal cords.
- They can affect the nasal and sinus passages – swelling in this area can cause anything from subtle problems with resonance / head voice, all the way up to a severe hyponasal voice. On top of that, postnasal drip can interfere with the vocal cords by requiring intermittent throat clearing or coughing, and can cause minor inflammation of the vocal cords directly as well.
- They can cause lower respiratory issues, such as bronchitis or pneumonia, which are fortunately less common. This obviously affects the voice tremendously – if you are having trouble breathing, then the voice will suffer. Additionally, the repetitive coughing can cause inflammation and swelling of the vocal cords.
So what can be done if you have the common cold and a performance coming up soon?
It is impossible to predict how long a specific cold will last in an individual person – it can be as short as 48 hours or it can last longer than a week, although most commonly they last 3-5 days. If the cold lasts longer than a week and doesn’t show signs of improvement, it is probably no longer a cold, and could be a sinus infection, bronchitis, or other more prolonged infections. Some people have a tendency to develop a more prolonged infection at the tail end of a cold.
As for anyone else, the general recommendation is hydration (however much water you normally drink in a day, increase it by 25-50%), and relative rest. For singers, this includes relative voice rest – if you need to practice, gentle warm-ups are usually ok, but try to stay away for the extreme ends of your vocal range, and never try to hit anywhere near maximum volume. A major danger for a singer with a cold is pushing the voice too hard: the swelling of the vocal cords increases the amount of force it takes to produce the same volume as before, so the strain it would take to belt the voice out could burst a blood vessel, triggering a vocal cord hemorrhage and/or a vocal cord polyp, which can lead to permanent voice damage.
There have been numerous conflicting studies about whether vitamin C and zinc may help with the common cold. There seems to be a modest benefit (a reduction in the length or severity of the cold) if vitamin C is taken prophylactically, and if zinc is taken within 24 hours of the onset of a cold.
Over the counter medications can help. For the nasal congestion, either nasal saline, which is milder, or oxymetazoline, which is much stronger (and never to be used for more than 3 days), can open things up. Tylenol or Advil can treat headache or sinus pressure. Oral decongestants can also help, but they frequently cause dryness in the back of the throat, which can affect the voice. Antihistamines are generally ineffective for a cold, though they can be used for allergies, and these have a drying effect also.
A lot of the time, the cold will improve with a little time, rest, hydration, and perhaps OTC meds. Some of the time, the best thing is to postpone or cancel a performance. But sometimes, the infection is still there and the show MUST go on. Apart from all the things listed above, prescription-only steroids are the last resort to rescue the voice. They work by quickly reducing the swelling of the vocal cords, and they generally also help very quickly with the nasal congestion. It is always ideal for the prescribing doctor to check the vocal cords and make sure there are no other conditions. Additionally, steroids are a potent medication, with potential side effects, and can be especially risky with various medical conditions. But in these rare cases, they can save the day for a professional singer.
As with any generic medical advice, none of this can substitute for customized diagnoses and recommendations by a voice specialist. All professional voice users and singers should have a voice specialist on standby in case issues arise.
Neil Prufer, M.D. is a voice specialist and otolaryngologist at ENT and Allergy Associates, LLP, in Williamsburg, Brooklyn.