Dr. Jahn answers readers’ questions about mucus, phlegm, and throat clearing.
Too Much Mucus?
Dear Doctor Jahn,
This is going to sound a bit gross, but I have an excess of mucus, so I’m always clearing my throat. It happens throughout the year so I don’t think it’s from allergies. I also don’t eat much in the way of foods like cheese and milk etc. It’s really bothersome and, as a result, I don’t think I am singing at my best. What can I do? (P.S. I don’t like taking strong meds.)
-Gary
Dear Gary,
Did you know that a whole book was once written about mucus? Titled De Catarrhis, it was written by Dr. Schneider in Wittenberg, Germany. The year was 1651, but almost 400 years later, the stuff continues to plague singers.
Mucus is a normal and important lubricant of mucous membranes. It helps to coat and protect (sounds almost like a patriotic motto, doesn’t it?) and is also involved in cleaning the surface of the membranes.
We all make and swallow between a pint and a quart of mucus every day. This mucus, a thin and slippery layer, passes through our GI tract silently.
Mucus typically becomes a problem when there is too much, or when it is of the wrong consistency (i.e. too viscous). To address your problem, you need to consider how to thin the viscous stuff out, and, if excessive, how to get rid of it.
Thinning out mucus requires that you drink lots of water. I recommend eight 8-oz glasses a day. Spread it out over the course of the day, and drink even a bit more if exercising or sweating. Washing it away, in turn, requires irrigating your nose with saline at least twice a day. Showering with plenty of hot steam also helps to loosen the stuff.
You need to also consider why you may be forming excessive (or thick) mucus in the first place. Any sort of inflammation, whether an infection or allergies, can cause excess thick mucus. Consider, also, that even normal mucus will adhere to inflamed surfaces, and then become symptomatic.
For this reason, patients with acid reflux irritation of the pharynx and larynx often complain of the need to clear their throat, and we will even see mucus sticking to the vocal folds when excessive singing has traumatized them.
By way of medical treatment, in addition to hydration and saline irrigation, consider treating reflux and allergies both by reducing your exposure to irritants and spicy foods, and possibly seeing an allergist or gastroenterologist.
If you decide to self-treat, one caution: beware of antihistamines that are drying and can make your mucus more tenacious. A dry larynx is not only difficult to sing with, but is more prone to injury and vocal nodules.
Make Friends With Your Mucus
Dear Doctor Jahn,
I am being assaulted by phlegm when I perform! I even hate revealing this! But when I get on stage the inner mucus production seems to go into over-drive and I am constantly clearing my throat and swallowing. I want to be free of this! How?
– Philippa
Great question, Philippa! There may be a number of reasons, and I have some suggestions for treating this. One thing you don’t want to do is to load up on drying antihistamines—you won’t be able to sing well, particularly the high, quieter passages, and the mucus will thicken. Your larynx needs to be moist and supple, but not coated with mucilage, that’s for sure.
Try the following. First, drink lots of water on the day of your performance (you should do this generally, but make a special effort on those days). Look at any medications you may routinely take which cause dryness; common ones are antihistamines, antidepressants, and diuretics.
If you have a choice, take these early in the morning or at night—after the show and before going to bed, rather than before singing. Next, clear your nose and upper passages of mucus. We all produce a pint to a quart of mucus a day; you need to clear the stuff out! If you can inhale some steam from a personal facial mask-type steamer, or in a shower, or even from a pan of hot water, that should help. Drip one or two drops of eucalyptus oil into the water.
You can also irrigate your nose with salt water before the show, just to clear out those recalcitrant bits that may be hiding in the back. If you are making more nasal mucus than usual (such as with allergies or a cold), consider using a topical vasoconstrictor such as Afrin or Otrivin nasal spray – this opens your nose but also reduces mucus secretion.
If you are prone to reflux, the acid can irritate the hypopharynx and larynx, making the mucus stickier and adherent to the vocal folds.
Take some antacids to reduce acid reflux. Even if you are not normally prone to reflux, you may get some “agita” before going on stage, so chewing on a Tums before the show may be helpful.
Finally, it is not uncommon nowadays for performers to have a cup of water, cold or hot, sitting on the stool or on the piano while they perform. Intermittent sips will carry the mucus away from your vocal tract and into your stomach where it will not cause you any problems.
Why is Phlegm Ruining My Student’s Range?
Dear Doctor Jahn,
I have a student that produces a lot of phlegm (heard as a “gravel-rattle” kind of sound) in his upper range of head voice. He’s not unwell (or been unwell) so it’s not connected to a virus or bacterial infection. It’s quite disconcerting as we’ve already worked on all the obvious things: trying to cut down on dairy foods, steaming, introducing more water, reducing stress, warming up gently etc. etc. but we haven’t seen any real improvement.
– Tracey
Yes, phlegm is a chronic issue, Tracey, one that is annoying to non-singers but a major problem for singers. In brief, phlegm is just thickened mucus. Mucus is a secretion that is formed in the upper respiratory tract and normally cleared back from the nose and sinuses into the pharynx and swallowed.
We do this unawares several times a minute, and generally manage to keep the upper aero digestive tract moist and free of any debris. When the mucus becomes excessive or too thick, phlegm forms, and this is not easily cleared, but tends to accumulate and cause problems.
In the larynx, phlegm often collects on the vocal folds at their point of maximal vibration (think of turning a skipping rope with a ring on it – the ring will wind up at the point of maximal excursion).
Since the vocal folds are thinnest, longest, and vibrate most delicately at higher pitches, the clump of mucus becomes most problematic in this range.
Here are some suggestions: first, thin the mucus by drinking about 64 oz (that’s eight 8-ounce glasses) of water a day. Next, wash the nose with a Neti pot twice a day to clear out excessive postnasal drip. Next, look at any possible allergies. In addition to inhalant allergies, consider food allergies as well. Apart from dairy and gluten, consider the excessive sugar found in sweets.
Mucus, whether excessive in quantity or consistency, often adheres to areas of irritated mucous membrane. A common cause of inflammation in the laryngeal area is laryngopharyngeal acid reflux, so this needs to be addressed with changes in diet and medical measures to reduce reflux.
Finally, excessive singing can cause irritation of the vocal folds in the area of maximal vibration. This is not nodes or a “pre-nodular condition.” simply irritation and mild swelling along the vibrating edge of the vocal fold. Mucus often adheres to this area, something that a laryngologist should be able to see and that you, as a voice teacher (perhaps with input from a vocal therapist), should be able to address.
How Can I Stop Constant Throat Clearing?
Dear Doctor Jahn,
I have a problem where I am always clearing my throat. I always have mucus on my vocal cords. I don’t have any allergies that I know of. Any suggestions?
– Amy
Dear Amy,
I have several thoughts. Do you drink enough water? You need 8-10 glasses a day (two with each meal, two between each meal), in addition to any coffee, tea or other drinks. Try to avoid milk products for a few weeks. Irrigate your nose twice daily with salt water to reduce any post-nasal drip. Try to avoid drying medications such as antihistamines, antidepressants, or decongestants. And finally, if you have any heartburn or gastroesophageal reflux, have it treated.
