The Dr. Is In : Avoiding Winter Colds: A Rational Approach

Dr. Jahn answers a reader’s question about avoiding winter colds.

Dear Dr. Jahn,

I’m 31, and for the past decade I’ve gotten 4–6 head colds every year between October and April. It doesn’t seem to matter that I get consistent sleep, exercise regularly, eat healthily, and generally manage stress well. I have a deviated septum and suffer from year-round allergies that I treat with Flonase, Allegra, and a daily neti pot. Both of my parents have also had sinus issues throughout their lives, but they don’t get sick half as much as I do. Are some people just cursed with being constantly sick during the winter, or are there more aggressive options out there for someone like me? While my colds aren’t usually very severe, they’re still disruptive to my career because I’m sick every two months during my busiest season. 

Thank you,

Christina 

W

inter colds are normally common, but they do seem to affect some more than others. And like so many common symptoms, while trivial to most people, colds can have a significant impact on your voice and your ability to work.

Although I have written several columns on this over the last 35+ years, we’ll take a slightly different approach this time and go through the steps of how the cold develops, what steps you can take to prevent it, and how to minimize the symptoms if you do fall sick.

By the way, did you notice how this last winter very few people caught colds or the flu? That was the silver lining (albeit thin, I admit) on the COVID-19 mask mandate. By covering our nose and mouth (and not touching our faces), the number of winter colds plummeted. 

This speaks to the first step in preventing colds. A cold begins when the rhinovirus enters your nose. Avoid this and you won’t catch a cold! So, wearing a mask, a scarf, or some sort of face covering—especially when at close quarters with others—is a good idea. Since it is an unfortunate possibility that some COVID variant will surge this winter, I would recommend continuing your mask habit during the upcoming cold season.

If the virus enters your nose, it needs to spend some time there, gaining a foothold and multiplying. With any infective agent, whether bacteria or virus, clinical infection is a matter of critical mass. How many viruses does it take to make you sick? We don’t know the exact number, but it makes sense to minimize the number and also limit the amount of time it spends in your nose. In this regard, hydration, which allows you to make lots of thin mucus, is helpful. 

Frequent nasal washing, whether with a neti pot or any of the other saline lavage devices on the market, is also beneficial. 

If your nasal passages are partly obstructed, this may prolong the time the virus spends in your nose and increase the opportunity for it to multiply and cause trouble. In fact, anything that interferes with the nasal lining’s normal ability to deal with viruses can worsen the situation. In your case, this would include not only a deviated septum but also the use of Flonase, which is drying and reduces the nasal lining’s normal defenses.

For many years, I have been a great advocate of vitamin C. Originally proposed by Dr. Linus Pauling, vitamin C has been shown to reduce the rate of infections from the cold virus. When the cold season starts, I advise my patients to preventively start taking 1000 mg of vitamin C daily—and if cold symptoms appear, to increase this to 4000 mg. This vitamin is water soluble, which means that your body will not accumulate it to possibly harmful levels. There are almost no contraindications to vitamin C, unless you are prone to forming kidney stones. At the cost of peeing out a little vitamin C daily, this regimen will go a long way toward preventing a cold. 

There are also many herbal teas and infusions that also open the nose and reduce the local effect of the cold virus. In this regard, you should do some reading about herbal and homeopathic remedies.

Inhaling warm steam is also helpful, since it raises the temperature inside the nasal passages and also washes away mucus and possible virus particles that are lodged there. A drop or two of eucalyptus oil in the steam is soothing and useful. Just make sure the steam is not too hot—using a facial steamer is a good way to go.

In terms of singing with a cold, here are a couple of points to consider. First, excess mucus can interfere with phonation, so hydration, mucus thinners (such as guaifenesin/Mucinex) and steam inhalation are good ways of reducing both the amount and the viscosity of the mucus. If the mucous membranes of the vocal tract become even slightly swollen, more of the sound you produce will be heard internally, by bone conduction. Consider that your voice will sound different (some think it sounds better), and you may unconsciously adjust your technique because of this. 

 

If the ears get blocked with a cold, your voice will again sound different. Decongestants can help, but you should avoid antihistamines since they are drying. You can take pseudoephedrine (Sudafed) by mouth and intermittently use a decongestant nasal spray. Mucinex D is useful in this regard.

And, finally, if your cold causes irritation of the mucous membranes or progresses to a cough, you may be prone to developing excessive muscle tension when you sing. If you cannot rest and wait the cold out, be sure that you work on relaxing the throat and lowering the larynx, either by vocal exercises or gentle massage of the larynx and neck.

In your particular case, I would also consider possible septal surgery to open your nasal passages, in order to allow mucus to move effectively through your nose. This, incidentally, may also generally improve your nasal resonance and facilitate moving the voice into the mask as you go into head register.

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.