Singing While Sick? : The Doctor Is In

Dr. Anthony F. Jahn

Once again, the cold season is upon us and contagion is in the air. While colds are generally not serious, they can have a significant impact on singers and their livelihood. I would like to share some thoughts about what to do if you develop a cold.

Ideally, of course, you should take a few days off, rest, and take vitamin C and over-the-counter remedies for symptomatic relief of your runny nose, cough, congestion, and other problems. You will not only get better faster, but will also be less likely to pass the virus along to unsuspecting colleagues.

Unfortunately, cancelling is not always an option. If you have an important engagement, if you are in an ensemble or opera with no cover, or if you just simply need to perform to get paid, you will face the problem of how to get through your cold quickly while also honoring your professional commitments. The reality is that while you may be able to take a few days off from a long-running show with a cover—or even cancel a lesson, choir rehearsal, or school project—backing out of a coveted and paid gig may be a luxury you cannot afford unless you are truly ill and simply cannot go on.

It is, of course, important to know when you really do need to cancel. If you are systemically ill with fever, joint or muscle aches, chills, and rigors, you most likely have the flu rather than the cold, and you may not be able to physically get through a concert or an opera. But a cold, with its symptoms confined mostly to the respiratory tract, is something you may be able to work around.

One of my favorite quotations in this regard comes from Dr. Norman Punt, an English laryngologist, whose book The Singer’s and Actor’s Throat is full of great advice and aphorisms. Punt says, “The difference between a professional singer and an amateur is that the professional can sing even when she doesn’t want to, and an amateur can’t, even when she does.” In other words, the well trained singer has some tricks up her sleeve that will allow her to get through a performance, even when dealing with a cold or other temporary impairment.

How does a cold affect the vocal mechanism? The cold virus typically enters the body through the nose, and the first symptom is usually nasal pressure and congestion. The pressure may extend to the sinuses, causing facial pain. Nasal discharge is next, which comes out through the nostrils with sneezing and nose blowing as well as exiting down the back of the pharynx.

As the infection travels south, pharyngitis may develop with swelling of the mucous membranes of the throat and increased mucus production. If the illness progresses, a cough may start progressing to tracheitis. When the symptoms do not resolve within a few days, a secondary bacterial infection may supervene, signaled by a change in the color of the mucus to yellow or green.

While this column is not specifically about treatment, my suggestions in this regard are a lot of vitamin C (I prefer the effervescent form such as Airborne or Emergen-C), warm ginger tea with honey, an anti-inflammatory such as ibuprofen, and symptomatic measures such as decongestants. Once the mucus changes color, a short course of antibiotics may be added if you don’t have the time to wait out the natural progression and resolution of the infection.

But how do you sing during this time? First, consider how the cold changes the vocal tract. Nasal and sinus congestion alters nasal resonance, making the voice hyponasal and thinner.

Paradoxically, your subjective perception of the voice may point to the other direction—some singers think they sound better with a cold. The reason for this is that the thickened mucus membranes absorb more of the sound energy, heightening bone conduction and proprioception in the mask. The reality, however, is that less sound is generated by air conduction—i.e., what the listener or audience may hear.

The mucosal edema caused by the infection also affects the walls of the pharynx. In the rigid-walled nasopharynx, some sound absorption and dampening may result. The volume of resonant space may be reduced. In the mobile oro- and hypo-pharynx, the swelling may also produce some impairment of muscular agility. The excess mucus formed can adhere to the larynx and the vocal folds, triggering a cough and throat clearing.

And, finally, if the infection progresses to the trachea and even the bronchi, it may become difficult to control the breath. Overall, the cold can produce a voice that is more nasal, smaller, less agile, lower in pitch or more limited in range, and less well supported.

So, what to do? Assuming you need to sing and are maximally medicated for your various symptoms, here are a few things to consider when you step out on the stage. First, accept your temporary impairment and cut yourself some slack! This does not mean that you shouldn’t sing to the best of your abilities—just scale back your expectations, keeping in mind the vocal limitations.

If you try to achieve your usual range and power, you may need to muscle and squeeze more to approximate the folds. This may be a reasonable temporary measure as long as once the cold is gone you consciously return to your usual good technique. If you continue to use excess muscle tension, then the compensation becomes the disease—which brings with it its own problems, such as increasing difficulty in the primo passaggio.

Regarding your range and agility, check to see what you can comfortably sing with your “cold” voice and try to stay within that range. If you can rearrange your program, transpose, or take the last note down rather than up, these may be good temporizing measures.

In terms of any lower respiratory impairment, you may not be able to sustain as long or as reliably with your cold. Can you shorten your phrases and rework your breathing to accommodate?

If appropriate for the venue, consider making an announcement. You will not only put less pressure on yourself but, in the audience’s eyes you will become a sympathetic figure, a true professional who will persist to give her best. Once offstage, immediately get back to focused cold management: rest and hydration. Minimize social situations to give your body a rest and to prevent spreading the virus to friends and colleagues.

If you do sing with a cold and have a lot of medications on board, keep in mind the possible side effects. All-purpose cold remedies usually contain three or four medications—possibly more than you need. They can also be drying (especially antihistamines, some cough suppressants and, to a lesser degree, decongestants) with deleterious effects on high and soft singing. It has now become a custom to prescribe steroids (sometimes together with an antibiotic) to reduce the inflammatory symptoms of an infection. Steroids, while they may make you feel better sooner, can also prolong the infection since they impair the body’s immune defenses.

Remember, a cold is a temporary illness, one that your body is normally capable of handling. While you may be able to sing during a cold, don’t expect to sing at your best. Support your body’s immune defenses. Rest, don’t exercise. Eat, don’t diet. And, above all, hydrate! Fluids help to clear inflammation and thin the mucus and generally will speed your recovery.

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.