ENT; Prevention

What to include in your ‘voice care lunchbox’ – and what to leave out

ENT; Prevention

Your voice is an important part of your livelihood, no matter your profession. A good voice care kit can help protect your vocal instrument.

On Season 21 of NBC’s popular singing competition The Voice, new coach Ariana Grande presented each of her team members with a unique gift – “a voice care lunchbox.” As the pop star with the powerhouse voice put it, “I want to help them maintain a healthy instrument … so they can sing for the rest of their lives.”

The vocal first aid kit, which includes tea, honey, and supplements, helped shine a spotlight on the importance of vocal health – particularly for professionals who rely on their voices, such as teachers, lawyers, clergy, and performers.

The COVID-19 pandemic forced many voice professionals to take an extended break, during which their vocal cord muscles could become deconditioned, just as an athlete’s legs might become weaker in the offseason.

As they return to the classroom, courtroom, and stage, they risk injuring their vocal cords if they don’t get back into adequate performing shape – especially during cold and flu season, when excessive coughing and laryngitis can lead to common voice injuries.

So, as a singer, otolaryngologist, and proud member of UT Southwestern’s Voice Center, I want to commend Ms. Grande for emphasizing vocal health to her team members and The Voice audience.

Of course, I couldn’t help but peek inside the “lunchbox” and weigh in on the effectiveness of some of the items. There are a few I might remove or replace, and I also would add a few more things for optimal voice care. Come to think of it, let’s make that lunchbox a backpack!

Warm teas: Include, if caffeine-free

Liquids you consume will never touch your vocal cords. So, warm beverages won’t cure or prevent vocal ailments, but they can help soothe throat symptoms and may make you feel better.

That said, hydration is key to vocal health. Choose warm (not piping hot) caffeine-free teas because caffeine can be dehydrating.

Honey, ginger, or echinacea drops or lollipops: Skip

Drops and pops that claim to soothe or coat the throat may comfort you, but there is limited research as to whether honey, ginger, or echinacea products can prevent or cure voice ailments. The UT Southwestern voice care team does not widely recommend these items, particularly because the FDA does not regulate them.

Dry mouth drops: Include

For years, we have recommended glycerin-based throat drops for professional voice-users, such as Grether’s Pastilles (which Ms. Grande included in her kits) and Halls Breezers. These products help soothe a sore throat and make you less likely to cough or clear your throat unnecessarily, which can harm your vocal cords.

Glycerin-based throat drops also increase oral moisture, preventing dry mouth and reducing the urge to clear and cough. Avoid using menthol-based lozenges, which can dry the mouth, irritating the throat tissues and cause you to reach for more drops.

Bromelain supplements: Skip

Bromelain is an enzyme that may contain anti-inflammatory properties and is found naturally in pineapple. We don’t formally recommend bromelain supplements for vocal hygiene – the U.S. Food and Drug Administration (FDA) does not broadly regulate supplements, so what you think you’re buying might include more, less, or other ingredients than what the label states.

The foods and supplements we consume affect us on a systemic level, meaning they might interfere with other medications or dietary choices. Talk with a nutritionist before starting an anti-inflammatory diet or supplement routine.

Related reading: Voice care: Sorting fact from fiction

While water doesn’t touch the vocal cords themselves, it hydrates you internally, which is key to vocal health.

More items for a voice care backpack

  • Water: Hydration is key to vocal cord health. While the water doesn’t touch the vocal cords themselves, it hydrates you internally. Daily intake needs vary – the average person should drink 64 oz. of water per day for optimal hydration.
  • Nebulizing saline or inhaling steam: This is the most direct way to get water droplets to the vocal folds themselves. We recommend the portable “Vocal Mist” nebulizer, which singer Lizzo uses to maintain her voice.
  • Mucinex (original formula): This over-the-counter medication helps thin mucus – a sticky substance that sometimes prevents the vocal cords from vibrating properly. Avoid the D or DM formulas for vocal health because these are decongestants and cough suppressants that tend to “dry out” your chest and throat. The goal is to achieve thin, watery mucus for proper voice box lubrication.
  • Humidifier: Add moisture to your environment with a humidifier. Dry air can lead to dry throats and vocal cords, particularly in the winter when we turn on our heaters.

Related reading: How COVID-19 can put your voice and life at risk

Common vocal injuries and tips to avoid them

Your vocal folds vibrate several hundred times per second, which causes heat and friction. With overuse, voice strain, or improper vocal cord lubrication, you are at increased risk for common vocal injuries such as:

  • Phono-traumatic lesions (polyps, cysts, nodules)
  • Inflammation and swelling of the voice box
  • Granulomas (trauma from coughing and throat clearing)
  • Chronic coughing

Certain injuries can be healed with rest and time, while others require voice therapy or minimally invasive procedures. More extreme cases might require surgery. Ideally, we can work to avoid injuries altogether.

Here are some common, simple ways to reduce your risk of a voice injury. Avoid these behaviors whenever possible:

  • Extended voice use
  • Speaking or shouting loudly
  • Straining your voice to be heard on video or phone calls
  • Clearing your throat, especially loudly
  • Excessive coughing

Always exercise reasonable use of your voice. If you feel you need a break from talking, take one. Use a microphone when speaking to a large audience. And don’t try to push your voice through illness.

With the shift to more online meetings, classes, and appointments, you might find yourself either out of practice for in-person speaking – or straining your voice to be heard and understood online. We know you are busy, but don’t wait until an injury occurs before you make your vocal health a priority.

To visit with a laryngologist, schedule an appointment or call 214-645-8898.