Subject: Answers for Singers with Colds
From:
Alice
Date: 24 Dec 03 - 12:07 PM
We've talked about vocal health in previous singing threads, and now that the virus season has really set in, I'm sure it is timely to post some info about singing and colds again. I am nursing a cold that came on two days before a two hour performance... I had to cut a couple of long songs and beef up the number of tunes on our gig list at the last minute. I got through that night ok, as the tickle in the throat was just starting. Now I'm in the midst of several days of bed rest, pseudophedrine, Nasonex, liquids, humidifier, and resting my voice. I have a three hour performance on New Year's Eve, after driving across Montana from Bozeman to Great Falls. I'm hoping this will resolve in time to perform ok on the 31st. Here is a web page with help for singers with colds. Note that Echinacea, which has become a real fad in recent years, is a placebo and does not really help with colds.
Alice
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http://www.scena.org/lsv/sv2-7/sv2-7Doctor.htm
Answers for Singers with Colds
by Dr. Francoise P. Chagnon, FRCS
Professional voice users dread the occurrence of upper respiratory tract infections which
herald the onset of vocal disability and threaten their commitments to professional
engagements. The "common cold" refers to a viral infection which affects mainly the nose
and throat. The "flu" refers to a more generalized influenza viral infection of the respiratory
tract associated with high fever, aches and pain. Other viruses may affect the larynx or the
trachea predominantly. The prevalence of such infections and the absence of curative
therapies leads to many myths and home remedies. Physicians share patient's
frustration in coping with these annoying recurrent viral illnesses. The best treatments
are dictated by common sense, as suggested by the following answers to frequently
asked questions:
Can anything be done to avoid such viruses?
The influenza vaccine offered each fall does not protect against all common colds or flu
viruses. The vaccine is based on the previous year's most virulent influenza virus strains.
Unfortunately, new viral strains keep arising for which you have no acquired immunity.
The virus spreads rapidly throughout the community by airborne and hand transmission
of nasal and throat secretions. The only way to diminish transmission of the virus is for
infected individuals to wear protective masks and gloves. In reality, it is not possible to
isolate oneself completely from the many viral epidemics which ravage our community.
Frequent hand washing and avoidance of close personal contact with individuals affected
by the common cold can minimize the chances of catching the disease.
Homeopathic medicines claim to improve one's immunity. If homeopathic medicines
have any benefit it seems to be on the long term and not when symptoms have already
manifested themselves. The same can be said for vitamins and mineral supplements.
Traditional medicine still maintains that proper nutrition, adequate daily rest and
minimizing negative stress in our lives, does more for the immune system than any
so-called remedies. Hormonal and metabolic disorders (such as diabetes or anemia)
may make you more susceptible to catching the cold or flu viruses and weaken your
ability to combat the disease.
I keep catching one cold after another! What is wrong with me?
Beware. What you believe to be recurrent colds may actually be exacerbations of chronic
sinonasal infections. Allergies are a common underlying cause. Allergies will cause
swelling of the lining of the nose and sinuses and favour the development of infection.
Anatomical deformities of the nose and sinuses such as deviations of the nasal septum,
often lead to mechanical obstruction of the sinus openings and narrowing of the nasal
passageways. The added swelling of the nasal lining by the cold virus simply favours the
retention of secretions of the sinuses. Other disorders of the nasal turbinates (those
special filters within our nose) that also lead to protracted upper respiratory tract
infections. Two to three common colds a year may be acceptable, particularly if you travel
a lot. Anymore than that deserves a proper medical evaluation (including special
radiographic imaging of the nose and sinuses) to seek underlying precipitating factors.
I caught a cold and I have a recital tomorrow. Should I cancel?
Once the virus has infected lining of the respiratory tract nothing much can be done to halt
it's progression. Medications, old folk remedies, traditional or alternative medicines, all
have palliative rather than curative effects. Nevertheless, they can hasten the resolution of
symptoms and prevent sinonasal or pulmonary complications such as sinusitis or
pneumonia. The ability to perform vocally while suffering from a cold has more to do with
the overall respiratory status than actual infection on the vocal cords. There are times
when the vocal cords may be capable of singing through the tenacious mucus but there
is no point in pursuing this task when the body is ill. Denying yourself time to recover only
lengthens the illness.
Cancelling a performance because of a bad cold or the flu requires professionalism.
Fainting on stage or collapsing after a performance or in the middle of a tour, will win you
empathy but will reflect poorly on your judgement. Having said that, I admit that
physicians are no better than singers and other professionals when acknowledging
one's limits. We are all guilty of pushing our bodies beyond the limits when there is a duty
to perform. Your laryngologist will understand your mindset when it comes to making a
decision to perform with a cold or the flu. A strict contraindication to singing would be the
presence of significant swelling or hemorrhage of the vocal cords. In my experience, this
is a rare finding. More often than not, it is the presence of sinonasal infection and a
productive cough as well as generalized malaise which will justify the need for vocal rest.
The singer may have already decided to cancel a performance but needs the formal
support of the laryngologist to convince the manager and to avoid financial penalties.
I have a cold. What should I do?
The principles of therapy are to decongest (decrease the swelling of the glands and
lining of the respiratory tract) and humidify. This will favour the expectoration of
secretions, improve nasal breathing and decrease coughing. A multitude of
over-the-counter medications are available for this purpose. You should avoid
medications which have drying side-effects (such as some anti histamines). While they
give temporary relief from a running nose, with repeated use they tend to make
secretions more tenacious and difficult to expel. Look for medications that are pure
decongestants (such as pseudoephedrine). Some formulations also include an
analgesic/anti-inflammatory (such as acetaminophen) to the decongestant to relieve
headaches and fever. Stick to medications which contain a single or few ingredients. It
will be easier to match the medications to your symptoms and minimize side-effects. If
decongestant medications leave you feeling jittery and unable to sleep (as if you have
had too much coffee) try taking a long acting (12 hour) preparation early in the morning
and none at night, or decrease the recommended dosage by half.
In addition to decongestant pills, you may use decongestant nasal sprays
(xylometazoline) for the rapid relief of nasal obstruction (particularly before sleep). Do not
use these nasal sprays beyond the recommended daily frequency and do not use more
than five days in a row. Saline nasal sprays, on the other hand, are innocuous and
beneficial to most nasal disorders. Generous vaporisations of the nasal passageways
with saline (four to five times a day, five vaporisations each nostril) is beneficial when the
nasal secretions are thick and purulent or when the nose feels dry and stuffy. Seek the
advice of your pharmacist in choosing medications which are compatible with your
metabolism and meet your needs.
Humidifying the ambient air and drinking plenty of fluids are well known precautions
taken by professional singers. In the absence of a humidifier, lock yourself into the
bathroom, run the shower to stream up the room while you drink a litre of mineral water.
You will not be cured by this ritual but you will have given your body the means to detoxify
itself. Ultimately, everyone finds their own remedy and ritual which works for them. You
will find that independent of the remedies used, the three "R"'s principles prevails;
Resign yourself to Rest and Recover.
The benefits of vocal rest and total body rest are underestimated. Returning the vocal
organ to it's most primitive function of respiration is the goal. It is during quiet respiration
that the laryngeal biomechanics are the most efficient. Forcing the larynx into phonation
when the biomechanics are not optimal calls for misuse of the laryngeal muscles. Quite
unbeknownst to the inexperienced singer, patterns of laryngeal muscular tension will
rapidly set in and remain even after the infection has passed.
Can a cold damage my vocal cords?
Upper respiratory tract viral infections rarely cause serious damage to the vocal cords.
The vocal cords will develop some swelling and will be weighted down by tenacious
secretions. The degree of vocal disability is usually out of proportion to the degree of
vocal swelling. In other words, you may sound terrible (or have no voice at all!) yet the
vocal cords don't look that bad. Coughing may bring worry that the vocal cords are being
damaged. In fact, coughing is a normal physiological reflexive function aimed at
protecting the lower respiratory tract from further infection. A productive cough which
expels secretions from the trachea should be assisted by the use of expectorant
medication (guaifenisin) and lots of humidification and hydration. It is the dry spasmodic
cough which seems to originate from a tickle in the throat which has the potential to
strain the larynx. A cough which interferes with sleep and impairs easy breathing should
be suppressed by dextromethorphan or codeine elixir. A protracted cough beyond 7 days,
requires medical evaluation to rule out bronchitis, pneumonia or asthma. It is not
unusual for the trachea and bronchus to retain a heightened sensitivity to irritants while
recovering from an infection.
Don't singers with colds deserve antibiotics?
Antibiotics will do nothing for the common cold. Unfortunately, they are prescribed by
physicians succumbing to patient's incessant demands. Antibiotics are not as innocuous
a believed. They can cause serious side-effects including allergic reactions to colitis
(inflammation of the bowel). It is best to reserve antibiotics for the treatment of
complications of the common cold such as sinusitis or tonsillitis or pneumonia. It is true
that respiratory tract infections that are initially of viral origin may be complicated by
bacterial infections. It takes a thorough physical examination and clinical judgement
(often substantiated by radiological investigations) to decide upon the need for antibiotic
therapy. Antibiotic therapy at the onset of a cold will not prevent complications from
occurring and will not shorten the duration of the illness.
While recovering from a cold when can I start singing?
If your cold did not affect the quality of your speaking voice, you may return to singing
within 48 hours of the acute phase of the illness. If your speaking voice is hoarse,
maintain voice rest as much as possible and reassess on a daily basis. Gentle
humming within your vocal range and deep breathing exercises will help clear tracheal
secretions and re-establish breath control and the pneumophonetic association. When
recovering from dysphonia, keep the total daily voicing to 4 hours non-continuous.
Progressively increase to 6 and 8 hours a day of voicing paying particular attention to your
"break-point" ( the point at which you start experiencing vocal fatigue). Do not push your
voice beyond your break-point. If you have not recovered full vocal efficiency within ten
days of the onset of your cold, a laryngeal examination is warranted to further guide your
rehabilitation.
Fortunately, the common cold and the flu are self-limiting infections, which resolve in 7 to
10 days. For the singer and vocal performer, full recovery may take 2 to 3 weeks, which
seems like an eternity when singing is your raison d'etre. The near future will likely bring
vaccination and antiviral medications to rid society of these common viral infections
which encroach on our quality of life.
Doctor Francoise P. Chagnon is Montreal born and educated and received her medical
degree from McGill University in 1981. She specializes in Otolaryngology and head and
neck surgery. In 1993, as a travelling fellow of the Royal College of Surgeons of Canada,
she perfected her subspecialty interest in laryngology and the professional voice at the
Vanderbilt University Voice Center. She is currently assistant professor of Otolaryngology
at McGill University and Director of the Voice Laboratory at the Montreal General Hospital.
She is a certified laser surgeon and a member of many professional societies, including
the Canadian, American and British Voice Foundations, and the American College of
Surgeons. She lectures frequently to voice students and professionals.
The Montreal General Hospital / McGill University Voice Laboratory is a diagnostic,
research and teaching endeavor of McGill University's Department of Otolaryngology. The
Voice Lab houses specialized equipment to study the human voice and its disorders.
This equipment includes digital audiovisual laryngostroboscopic examinations and
sound spectrography. The Voice Lab caters to all individuals presenting with voice and
throat disorders as well as providing expertise to singers and professional voice users.
The Voice Lab is staffed by a multidisciplinary team consisting of technicians,
speech-language pathologists, voice scientists and laryngologists. Appointments are
given upon referral at the following number 514-937-6011, ext. 2285. For further
information, please contact Doctor Francoise P. Chagnon at the same number or fax your
inquiries to 514-934-8200.
Ask the Throat Doctor
Do you have any specific questions for Dr. Chagnon about the voice or vocal ailments?
Submit them to Ask the Throat Doctor c/o La Scena Vocale, 5411 Waverly, Montreal,
Quebec, H2T 2X8, or by email at chanw@ere.umontreal.ca
Does Echinacea help cure the common cold?
Not according to a study reported in the February 25th broadcast of the CBC TV show
Marketplace. - WKC
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sj
