Dr. Jahn: Winter & Your Voice

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s we face the uncertainty of this cold season, continue to strive for good health in yourself and for those around you.

Respiratory viruses (including the coronavirus family) tend to surge in cold weather for several reasons. The enforced physical proximity to others in enclosed spaces allows respiratory viruses to spread infection more easily. These viruses are spread through the aerosol of droplets we project each time we speak.To start with an understatement, last year was a most unusual year. The unprecedented impact of COVID-19 and the associated stress—for many economically, but for all psychologically—has left many scrambling to reinvent a new reality. And as we approach the confluence of cold weather, colds and flu season, and the ongoing persistence (and resurgence) of the coronavirus, you need to consider some important measures in order to preserve your health as well as your voice.

Studies of speech, as well as singing, have shown that depending on how loudly we use our voice, the distance these droplets travel can increase up to six fold. Even quiet singing can put out a cloud of vaporized saliva covering a one-meter perimeter around the performer (obviously, more to the front than to the sides and back). Over the last 40 years, I have often stood in the wings of an opera stage and seen this spray, dramatically illuminated from the side, as the soprano performs a big aria.

Furthermore, this cloud can persist for several minutes after the singing (or even breathing) has ceased. Consider for a moment the many situations where you may need to stand closer than three feet to another person, especially in confined spaces such as public transportation—but also think about situations where you enter a recently vacated space, such as an elevator someone has just left.

A second feature to consider is air humidity. When the air is dry, particulate matter, such as dust and animal dander, remain in circulation longer and can cause symptoms of winter allergy. Inadequate hydration of mucus membranes allows these allergens to travel farther into your body, rather than being trapped just inside the nose.

Our bodies may also be less resistant to infection in the winter. In the northern parts of the country, outdoor exercise becomes more cumbersome and less attractive. Gyms, if not closed, can heighten exposure to others who are potentially infected. Further, the lack of sunshine and relative decrease in fresh greens and fruits can reduce our vitamin levels. In this regard, several recent publications have suggested that low vitamin D levels (a very common condition) may increase our vulnerability to viruses such as COVID-19.

Psychological problems, such as seasonal affective disorder, can further lead to a weaker immune system due to stress and a lack of motivation to take care of ourselves. Viktor Frankl, an eminent Austrian neurologist, showed in his writings the importance of optimism and a positive state of mind when it comes to surviving the most stressful of times.

So, here are some concrete suggestions to help you, your spirit, and your voice get through this especially dark winter.

First, get a good humidifier! My personal favorite is the Venta Airwasher, available on Amazon. This is a humidifier that is strong, quiet, easy to clean, and puts out a lot of water. It should be on when you first turn the heat on and run constantly at low speed. If you can also keep the heat in your home (or at least in the bedroom) down, you may just be able to avoid colds this winter.

You need to clean and refill your humidifier regularly to make sure it is working properly. If you happen to own a piano, your instrument will also appreciate the extra humidity and stay in tune longer.

Don’t forget to keep drinking water. We are more sedentary in the winter and possibly less thirsty, but water intake is essential in dealing with dryness. It allows us to produce lots of thin mucus, which traps and disposes the many environmental invaders—whether allergens, bacteria, or viruses—that can enter the body through the respiratory tract. Switching from cold water to a warm herbal tea may be a good alternative if the weather gets really cold.

Next, if you don’t normally get a flu shot, this may be a good year to start. Although the efficacy of these shots is far from 100 percent, you can significantly reduce the likelihood of catching the flu and transmitting it to others. While the flu vaccine does not immunize you against COVID-19, an alerted and activated immune system may be of some benefit against other viruses.

Next, take your vitamins! Vitamin D, normally synthesized by the body in response to sunlight, may be in short supply over the winter, so consider taking it daily. Vitamin C has also been shown to be helpful in preventing infections. A word of caution: vitamin C is water soluble, so it is difficult to take too much—the body just excretes the excess. Vitamin D, on the other hand, is fat soluble and too much can cause toxicity.

While we are all tired of our COVID-19-inflicted lives (the novelty has certainly worn off!), we need continued vigilance in terms of our social exposure. But remember—you may be tired of COVID-19, but COVID-19 isn’t tired of you, and the virus continues to be widespread and potentially fatal. The virus has no brain, no sympathy, and no forgiveness, so wishful thinking remains just that.

To end on a happier note: the mask you are wearing as a COVID-19 precaution (and you are wearing your mask, right?) will likely reduce the incidence of colds and flu this year, since all these viruses are spread through droplets. So, frequent handwashing, masks, and social distancing—all implemented as anti-COVID-19 measures—may just make us generally healthier this winter!

Anthony Jahn, M.D.

Anthony Jahn M.D. is an otolaryngologist with a subspecialty interest in ear diseases, disorders of hearing and balance, and disorders of the voice. He is a professor of clinical otolaryngology at Mount Sinai School of Medicine and is the noted author of Care of the Professional Voice. For more resources, go to his website www.earandvoicedoctor.com.