The classic caricature of the opera singer usually depicts a buxom soprano (or short tenor) sitting at a dressing table, spraying some concoction into the throat while vocalizing.
Many singers use gargles or inhalers to address afflictions of the throat and to try to improve the voice. The purpose of these maneuvers is to bring a solution in direct contact with inflamed areas in the upper respiratory tract, and they can be very effective if properly used. This column will try to give some scientific and practical background to a time-honored ritual.
For gargles and inhalers to work, they must reach the appropriate parts of the upper respiratory tract. As you may already know, rinses or mouthwashes have no benefit specific to the singer. They stay in the anterior two thirds of the mouth cavity, and are helpful for dental problems or infections affecting the mouth (such as a yeast infection of the gums or palate). If you use mouthwashes, they should be saline or peroxide-based, or medically prescribed.
Commercial mouthwashes, if used regularly, can actually do more harm than good. They temporarily reduce the bacterial count in the mouth—but they also damage the mucous membranes. The remaining bacteria reproduce rapidly, and within an hour they are back in full force, now free to act on damaged mucous membranes. Good dental care will do more for bad breath than commercial mouthwashes.
Many singers use gargles for sore throats. Gargling involves holding a quantity of solution in the back of the throat while blowing air out. This causes the solution to bubble and percolate, soothing the mucous membranes it contacts. The best gargle is a solution of warm water and salt or baking soda. The heat helps to increase circulation to the infected part of the throat; the salt pulls fluid from the tissues and reduces swelling. The classic British actor’s gargle—port wine—probably had more effect after it was swallowed.
When should you gargle? When you have a sore throat, pharyngitis, or tonsillitis. Radiologic studies have shown that the gargled solution does not go past the posterior tonsillar pillars (the back of the oropharynx). Gargles are therefore of no benefit for laryngitis or any other laryngeal condition.
One final gargle-related point: A voiced gargle is no more beneficial than an unvoiced one.
To get a solution farther down the respiratory tract, it must be either a vapor or in aerosol form. The most common vapor is steam (water vapor), although certain volatile oils may also be carried with steam into the throat. A drop or two of eucalyptus oil in boiling water makes a soothing inhaler, taking advantage of both the heat of the steam and the medicinal effects of the volatile oil. This is the main advantage of steam, that it also carries heat to the involved areas.
Since steam is usually inhaled from a pot or through a mask, the warming and moisturizing helps the nose and nasopharynx, as well as the pharynx and larynx. Steam can travel as far as the upper trachea, but inhaled water vapor cools rapidly and precipitates, normally creating a watery coating no farther down than the lower pharynx and upper part of the larynx. To get steam farther down involves inhaling it either at higher temperatures, more rapidly, or closer to the source. This creates the risk of a burn, and should be avoided.
If you are using a vaporizer to humidify your bedroom, there is no benefit to hot vs. cold. Either way, by the time the water droplets reach your respiratory tract, they will be cool—or at most, body temperature.
Aerosols are mixtures of air and finely dispersed particles of liquid or solids. The oft-caricatured throat spray in fact generates a liquid-based aerosol that can soothe the throat. Depending on how rapidly you inhale, you can get these droplets to land on the vocal folds. The water particles in spray bottles are rather large, and will not travel below the larynx
For tracheitis and bronchitis, you may need to use a nebulizer. This is a device that shatters a solution into tiny particles. These particles have less weight than sprayed water droplets and are carried farther down into the lungs. Different methods are used to nebulize liquids (such as the ultrasonic nebulizer).
These devices can be very helpful in true medical conditions, such as croup or asthma. But they also carry a potential danger: They allow you to carry materials (not just water or volatile oil vapor) deep into the lungs, where they may actually cause harm. Dr. Wilbur Gould told me years ago that Tebaldi’s career ended because she was inhaling nebulized oil to lubricate her vocal folds, and developed lipoid pneumonia, losing flexibility in the lungs. It is for this reason that I have no problem with patients steaming, but I get concerned when they buy nebulizers. Of course, if this is done to treat a pulmonary condition (under the supervision of a pulmonologist), it is acceptable.
While on the subject of pulmonary disease, if you use inhalers to treat asthma, be sure you know what you are inhaling, both the medication AND the vehicle. Advair, a currently popular asthma inhaler, has a high incidence of associated temporary hoarseness, probably due to the vehicle used to carry the steroid into the lungs.
In summary, all of these methods have benefits, and are especially useful for acute inflammatory conditions—but be sure that what you take into your body will reach the area you are treating, and will not cause harm.
Disclaimer: The suggestions given by Dr. Jahn in these columns are for general information only, and are not to be construed as specific medical advice or advocating specific treatment that should be obtained only following a visit and consultation with your own physician.
