Cold and flu season brings a special challenge for singers: keeping the voice healthy while everyone else is coughing. Even a mild upper respiratory infection (URI) can disrupt vocal fold vibration. When singers push through illness, they increase the risk of swelling, strain, and lingering fatigue. Fortunately, research offers clear, practical ways to protect the voice during recovery.
A. Understand What Is Happening: While “cold” and “flu” are often used interchangeably, influenza typically appears suddenly with high fever, chills, and body aches, while the common cold develops more gradually with nasal congestion, sore throat, and mild cough (Schoor, 2025; Boktor, 2023).
When illness strikes, the vocal folds often swell with fluid, increasing the effort required to phonate. Michael and Goding (2012) warn that singers who “sing over a cold” risk serious injury. Swollen vocal folds make singing feel effortful, often limiting the upper range, delaying the onset of tone, and adding roughness to the sound. The problem lies less in the cold itself and more in the decision to keep performing.
Acute laryngitis is temporary swelling from infection or overuse. Most singers recover with rest, hydration, and gentle vocal use. If hoarseness lasts beyond three weeks, a laryngologist should evaluate the folds directly.
B. Hydrate from the Inside and the Outside: Hydration forms the foundation of vocal health (Behlau, 2009). Singers maintain two kinds of moisture: systemic hydration, achieved by drinking fluids, and superficial hydration, achieved by humidifiers or saline nebulization.
Kaya and colleagues (2025) demonstrated that 22 minutes of dry-air breathing raised perceived vocal effort and reduced vocal quality, while nebulizing 0.9% isotonic saline improved voice measures and restored ease of phonation. Souza et al. (2021) found that a 10-minute saline nebulization increased glottic closure and raised fundamental frequency, suggesting thinner mucus and freer vibration. Supreetha et al. (2024) showed that warm, moist inhalation reduced phonation threshold pressure and improved both acoustic quality and singers’ self-ratings. Together, these studies confirm that singers perform best when they maintain both internal and surface moisture.
Dlamini (2025) further notes that while hydration supports mucosal health, moderation matters: excessive water intake during respiratory illness may, in rare cases, contribute to electrolyte imbalance. The key is to balance hydration enough to keep mucus thin without overcompensating.
Practical tip: Use steam inhalation, a room humidifier, or isotonic saline nebulization to support surface moisture.
Drink warm water regularly to sustain internal hydration.
C. Choose Helpful Remedies and Skip the Harmful Ones: Not every home remedy helps the voice. Meenan (2016) evaluated common practices such as lemon, ginger, and herbal teas and found little consistent evidence of benefit. Certain ingredients, including menthol, alcohol, and acidic additives, have a drying or irritating effect on the laryngeal tissues, and this irritation can create a negative cycle of throat clearing, further dryness, and vocal fatigue.
Honey stands out as an effective exception. Paul et al. (2007) showed that buckwheat honey relieved cough and improved sleep better than dextromethorphan or placebo. Odowole et al. (2018) confirmed honey’s soothing and antimicrobial properties in a systematic review. For singers, dark honey offers a safe, natural way to calm the throat and reduce coughing.
Dlamini (2025) found mixed evidence for vitamin and mineral supplements: vitamin C and zinc may slightly reduce the duration of illness in some populations, but high doses can cause gastrointestinal upset or interfere with certain medications. Supplements are optional for recovery.
Pharmacy-based studies (Blenkinsopp, 2025; Schoor, 2025) also warn that many combination cold and flu medications provide limited clinical benefit and may cause dryness, rebound congestion, or other side effects. Singers should choose simple, targeted treatments such as saline sprays or acetaminophen, and avoid prolonged use of topical decongestants beyond 3-5 days.
Caution with pain relievers: While aspirin and ibuprofen reduce inflammation, they also increase bleeding risk. For singers recovering from illness, even minor capillary fragility in the vocal folds can lead to hemorrhage. Combine any use of these medications with strict vocal rest—avoid singing, humming, or even whispering until cleared by a laryngologist. Use acetaminophen instead if pain relief is needed without this risk.
D. Gargles: Warm salt-water gargles can help soothe throat irritation and clear mucus during recovery. A mild solution of about ½ teaspoon of salt dissolved in a cup of warm water provides gentle cleansing and moisture without irritating the vocal folds. Avoid gargles that contain alcohol, lemon, or antiseptic ingredients, which can dry or sting the mucosa. Remember that gargling helps with comfort but does not speed recovery or treat infection; its benefit lies in maintaining a clean, moist environment as the voice heals.
Research by Orbelo and colleagues (2024) found that gargle phonation —vocalizing while gargling water —can reduce perceived vocal effort and improve acoustic measures in singers and patients with mild muscle tension dysphonia. Unlike simple salt-water gargling, this method engages airflow and gentle phonation to rebalance tension in the laryngeal and supraglottic muscles. Gargle phonation can be a valuable rehabilitation tool once inflammation subsides, helping singers restore efficiency and vocal ease.
E. Use Lozenges Wisely: Lozenges can soothe a dry throat, but not all are singer-friendly. Menthol, eucalyptus, and alcohol-based lozenges may temporarily numb or cool the throat while actually drying the vocal fold surface and decreasing a singer’s sensation. Acidic formulations (such as those containing citric acid or lemon) can worsen irritation or reflux.
Better options include:
Glycerin-based lozenges (e.g., glycerol or pectin) that coat without numbing.
Slippery elm or marshmallow root products, which provide natural mucosal coating (if tolerated).
Mild saline or honey-based drops to maintain surface moisture.
Practical tip: Use steam inhalation, a room humidifier, or isotonic saline nebulization to support surface moisture.
Drink warm water regularly to sustain internal hydration.
C. Choose Helpful Remedies and Skip the Harmful Ones: Not every home remedy helps the voice. Meenan (2016) evaluated common practices such as lemon, ginger, and herbal teas and found little consistent evidence of benefit. Certain ingredients, including menthol, alcohol, and acidic additives, have a drying or irritating effect on the laryngeal tissues, and this irritation can create a negative cycle of throat clearing, further dryness, and vocal fatigue.
Honey stands out as an effective exception. Paul et al. (2007) showed that buckwheat honey relieved cough and improved sleep better than dextromethorphan or placebo. Odowole et al. (2018) confirmed honey’s soothing and antimicrobial properties in a systematic review. For singers, dark honey offers a safe, natural way to calm the throat and reduce coughing.
Dlamini (2025) found mixed evidence for vitamin and mineral supplements: vitamin C and zinc may slightly reduce the duration of illness in some populations, but high doses can cause gastrointestinal upset or interfere with certain medications. Supplements are optional for recovery.
Pharmacy-based studies (Blenkinsopp, 2025; Schoor, 2025) also warn that many combination cold and flu medications provide limited clinical benefit and may cause dryness, rebound congestion, or other side effects. Singers should choose simple, targeted treatments such as saline sprays or acetaminophen, and avoid prolonged use of topical decongestants beyond 3-5 days.
D. Gargles: Warm salt-water gargles can help soothe throat irritation and clear mucus during recovery. A mild solution of about ½ teaspoon of salt dissolved in a cup of warm water provides gentle cleansing and moisture without irritating the vocal folds. Avoid gargles that contain alcohol, lemon, or antiseptic ingredients, which can dry or sting the mucosa. Remember that gargling helps with comfort but does not speed recovery or treat infection; its benefit lies in maintaining a clean, moist environment as the voice heals.
Research by Orbelo and colleagues (2024) found that gargle phonation —vocalizing while gargling water —can reduce perceived vocal effort and improve acoustic measures in singers and patients with mild muscle tension dysphonia. Unlike simple salt-water gargling, this method engages airflow and gentle phonation to rebalance tension in the laryngeal and supraglottic muscles. Gargle phonation can be a valuable rehabilitation tool once inflammation subsides, helping singers restore efficiency and vocal ease.
E. Use Lozenges Wisely: Lozenges can soothe a dry throat, but not all are singer-friendly. Menthol, eucalyptus, and alcohol-based lozenges may temporarily numb or cool the throat while actually drying the vocal fold surface and decreasing a singer’s sensation. Acidic formulations (such as those containing citric acid or lemon) can worsen irritation or reflux.
Better options include:
Glycerin-based lozenges (e.g., glycerol or pectin) that coat without numbing.
Slippery elm or marshmallow root products, which provide natural mucosal coating (if tolerated).
Mild saline or honey-based drops to maintain surface moisture.
F. What About Vitamin Supplements? Vitamin supplements like vitamin D, vitamin C, and zinc often appear in singer wellness discussions. While these nutrients are essential for immune and muscle function, research has not confirmed a direct improvement in voice quality or recovery time.
Vitamin D supports muscle tone, immune balance, and neuromuscular coordination. Deficiency may contribute to vocal fatigue or slower recovery, though studies show no consistent correlation between low vitamin D and measurable dysphonia (Hamdan et al., 2019; Hamdan et al., 2023).
Vitamin C remains popular for cold prevention, but clinical studies show only a slight reduction in illness duration—usually less than one day—and no prevention benefit for most people (Dlamini, 2025). High doses can irritate the stomach and, in singers prone to reflux, may increase acid-related throat irritation.
Zinc may shorten the duration of cold symptoms if taken within the first 24 hours of onset. Excess zinc can cause nausea or interfere with copper absorption.
Over-the-counter supplements should never replace medical evaluation or balanced nutrition. If you suspect a deficiency, ask your physician to test serum levels before adding supplements.
Bottom line: Moderate, physician-guided supplementation can support whole-body recovery, but it is not a substitute for hydration, rest, and evidence-based vocal care.
G. Recognize When to Seek Professional Help: Persistent hoarseness warrants medical evaluation. The Cleveland Clinic (2024) and Mayo Clinic (2024) both advise seeing a laryngologist or voice-specialized speech-language pathologist when vocal or speech changes last longer than two to three weeks, or sooner if a singer experiences pain, sudden loss, or blood in the sputum.
Caution with pain relievers: While aspirin and ibuprofen reduce inflammation, they also increase bleeding risk. For singers recovering from illness, even minor capillary fragility in the vocal folds can lead to hemorrhage. Combine any use of these medications with strict vocal rest—avoid singing, humming, or even whispering until cleared by a laryngologist. Use acetaminophen instead if pain relief is needed without this risk.
Singers benefit from seeing clinicians experienced in performing arts medicine or a dedicated laryngologist, professionals who understand the demands of performance voice (McKinnon-Howe & Dowdall, 2018). Early assessment and imaging help prevent small problems from becoming chronic vocal injuries.
H. Prevention and Flu Vaccination: Annual influenza vaccination remains one of the most effective ways to reduce vocal downtime. Vaccination lowers both the intensity and duration of symptoms and reduces the likelihood of complications such as bronchitis or pneumonia (Boktor, 2023; Dlamini, 2025). Singers with frequent travel or teaching schedules should prioritize vaccination early in the season to minimize disruption during high-performance months.
During flu season, protect your voice as an athlete protects muscle: with rest, hydration, and informed care. Your voice will recover faster and stay stronger when you give it time and science-based attention.
With gratitude for all who sing and teach,
Jamea J. Sale, PhD
Director, Institute for Healthy Singing & Voice Research
Sing for a Lifetime
JSale@HealthySinging.org
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