Dear Dr. Jahn: I’m a Classical Singer reader and have enjoyed your articles over the years very much. It’s nice that you’ve remained a constant as other magazine elements have come and gone.
Two questions:
I really enjoy steam rooms, and steaming my throat with a portable steamer. It feels really good and I have the impression that it does the throat/vocal cords good. Obviously the warm moisture is good for them, but I wonder if I’m fooling myself to think that after a hard day of singing, when my voice is tired, that sitting in a steam shower for 20 minutes will help my voice recuperate while I sleep. Am I?
On the flip side: smoke. Obviously it is drying and harsh in a hot, dry kind of way, and cigarettes have the general dangers of cancer and such. But I have always liked the feel of smoke in my lungs, and inhaling [it]. [There is] something comforting and relaxing about it.
Aside from the obvious cancer issues, how does smoking affect the singer adversely? And is marijuana much worse than cigarettes? I attended a class once with a big-name ENT/voice doctor who said that smoking marijuana is not all that different than just rolling up a pile of garbage and smoking it. Why is it that marijuana should be so much worse than regular tobacco?
—Steam Lover
Dear Steam: Let me try to address your three questions. Steam is very good for the respiratory tract in general, provided that it is clean and not too hot. It washes the lining of the throat, trachea, and bronchi, and allows you to expectorate more easily. The warmth is probably also useful, since it increases the circulation to the area, and in theory at least, allows the muscles in the area to clear out any waste products, such as lactic acid. Again, be careful not to scald your throat with hot steam. In a steam room, sit away from the steam generator. If it is still too hot, try to breathe through your nose.
Smoking, on the other hand, is bad. If you are serious about your singing, and particularly the longevity of your career, you need to stop smoking. Cancer is not the real issue here—chronic obstructive pulmonary disease is. Relatively few people get the former, but every serious smoker eventually gets the latter. It means you will have difficulty supporting the voice, develop chronic bronchial inflammation with excess mucus’ and not be able to inhale or exhale fully. Even in the short term, nicotine paralyzes the cilia in the trachea and bronchi so you will have difficulty clearing the tar, tobacco debris, and mucus out of your respiratory system.
The additional problem with marijuana is that it is not filtered. The smoke is hotter, and you can inhale larger particles into your lungs. If you do smoke marijuana, it is better to use a water pipe than to smoke a joint. From the chemical point of view, I don’t believe THC is “worse for you” than nicotine, however. If you persist in smoking (knowing that this will adversely affect your aging and shorten your career), then continue steaming as well.
Good luck!
—Dr. Jahn
Dear Dr. Jahn: I’m a 19-year-old tenor with acid reflux. When I first started singing, at about 16, I was a first tenor or possibly an alto. I woke up one day and my voice sounded muffled and was not as free as it used to be. I didn’t know what had gone wrong, so I accepted the fact that I had become a baritone.
Before my voice changed I had mastered the legato for my age and singing was free and easy. Afterwards it was like starting all over again. The once enjoyable legato warmups were an obstacle and my singing became forced. Because of this I experienced pain on the left side of my throat for about two years.
When I got up to the college level I expressed my concern to a professor, who told me to remain silent until I got checked out. Long story short, I saw the doctor, and to my surprise he told me I had acid reflux. I was prescribed Nexium (40 mg).
Within the first few days, I [started] to sound like the high first tenor I was in the past. The vocal flexibility was also [coming] back. Unfortunately, I had an allergic reaction to the Nexium. I was forced to try Omperozole (20 mg), which is also known as Prilosec. With the Prilosec I changed my diet, and even elevated my bed the suggested six inches. The first improvements that I noticed were, one, the pain was gone, two, no more dry throat, and three, my sinuses cleared up.
The only thing is that I wake up with thick mucus on my folds and I still can’t sing properly. This mucus doesn’t go away. This time around the doctors told me that my throat is starting to look great, but they saw the mucus and prescribed Mucinex. I’ve been on that for some time now, and I still have mucus on my cords. I’m drinking at least eight glasses [of water] a day and the stuff just stays there. What else is there to do?
—Reflux
Dear Reflux: It does sound like you have reflux. You had a positive response to two different proton pump inhibitor medications. You didn’t mention whether you are overweight. If you are, you need to lose weight. I would also start to take an antacid along with whichever PPI you are currently taking. I would suggest Gaviscon. At the minimum, take one tablespoon of liquid Gaviscon at bedtime.
If you continue to have reflux, you need to see a gastroenterologist, and consider a 24-hour pH monitor test. If the reflux is confirmed, and cannot be medically controlled, an endoscopic fundoplication may be helpful.
Just be absolutely sure that there is no other problem causing your vocal difficulties, and remember that I am only responding to what you have described, without the benefit of a clinical evaluation.
—Dr. Jahn
Dear Dr. Jahn: I am a mid-40s female singer who just had the unpleasant experience of nearly choking to death yesterday on a vitamin tablet. (Fortunately, another adult was with me who was able to perform the Heimlich maneuver.) Afterwards, I coughed up a few drops of fresh blood and now am extremely swollen in the subglottal region and have no voice.
The on-call physician to whom I spoke immediately afterwards warned me that the tablet most likely scraped up the inside of my trachea, and that most people experience significant swelling for 48 to 72 hours after such an event. I do not know, however, if that time frame will be long enough to allow me to return to the demands of singing or even teaching.
I plan to consult my ENT as soon as he is available in order to try to ascertain whether the damage was just to my trachea, or if my vocal folds themselves were directly injured. I understand that if the blood was due to a vocal-fold hemorrhage, the situation must be monitored and vocal rest maintained until the injury heals and all the spilled blood is reabsorbed. Would the same rules apply if the hemorrhaging was just in the trachea itself?
I do not want to go off of complete vocal rest too soon and risk compounding the injury. Further, what course of treatment would one generally follow for a tracheal injury? I have a very strong yeast response to even minimal steroid doses plus a history of vocal-fold hemorrhage, so I’m not wild about taking steroids—something mentioned by the on-call physician—unless there really is no other course of action.
—Trauma Survivor
Dear Survivor: I’m sorry you had this incident—it is very unpleasant, and I’m glad you are all right. Regarding your questions, it is unlikely (although not inconceivable) that you damaged the vocal folds. Pills typically lodge either in the area behind the larynx, at the beginning of your esophagus, or, on occasion, go into your trachea, causing you to cough the pill up.
As far as your symptoms go, if you are not wheezing on inspiration or expiration, the amount of swelling to the upper airway is not worrisome, and should resolve. Also, if you are able to swallow soft foods without discomfort, it is unlikely that you have seriously damaged your esophagus. Your loss of voice can occur from edema, but also from a reflex contraction of the pharyngeal muscles, which can pull the larynx up and forward, like a severe case of muscle tension. Bleeding could come from a superficial scratch of the mucous membranes in either the airway or the digestive tract.
Certainly, rest your voice. In the absence of airway obstruction (wheezing) or pain on swallowing, you should not need any steroids. Drink lots of liquids. Avoid aspirin or other non-steroidal anti-inflammatories (like Advil), but you can take Tylenol if necessary. If you do have pain, especially worsening pain, or fever, then you need to see a physician right away. Otherwise, get to your ENT as soon as convenient, to assess whether there has been any injury to your vocal apparatus.
—Dr. Jahn
DISCLAIMER: The suggestions Dr. Jahn provides in these columns are for general information only, and not to be construed as specific medical advice or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
