Attack of the Phlegm

Duo singers and doctor
You can get on stage with a clear head… and nose - says Dr. Jahn

Oh, Dr. Jahn,

I am being assaulted by Phlegm when I perform! I even hate revealing this! But when I get on stage the inner mucous production seems to go into over-drive and I am constantly clearing my throat and swallowing. I want to be free of this! How???


Great question! 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. You 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 more sticky, 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.

-Anthony F. Jahn, MD, FACS, FRCS(C)

This discussion is for general information and not to be construed as specific medical advice that you should obtain from your own physician.

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