Dear Dr. 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
Dear Tracey,
Yes, phlegm is a chronic issue, 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 aerodigestive tract moist and free of any debris. When the mucus becomes excessive or too thick, phlegm forms, 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 sweets – excessive sugar.
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 laryngopharyngal acid reflux – so this needs to be addressed with changes in diet and medical measures to reduce reflux.
Finally, excessive singing, either belting or pushing, can cause irritation of the vocal folds in the area of maximal vibration.This is not nodes or a “prenodular 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 you, as a voice teacher, perhaps with input from a vocal therapist, should be able to address.
-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.
Dr. Jahn is an internationally renowned otolaryngologist based in Manhattan with a sub-specialty interest in the professional voice. His practice includes classical and popular singers. He holds academic appointments at Mount Sinai School of Medicine and Westminster Choir College in Princeton. He is Medical Director at Jazz at Lincoln Center, and former Director of Medical Services at the Metropolitan Opera in New York. Dr. Jahn has published several books for vocalists, including “Vocal Heath for Singers” (Singdaptive) and “The Singer’s Guide to Complete Health” (Oxford University Press).
