Top ENT Answers Four Seasonal Singing Questions ⏱ 3 mins

November 28, 2022

Can you sing with a cold? Are antihistamines bad? We put these questions and more to top ear, nose and throat surgeon Declan Costello. Here’s what he had to say.

With the cold and flu season upon us, the Singing Teachers Talk podcast put a few seasonal singing-related questions to leading laryngologist Declan Costello.

Mr Costello is a consultant ENT surgeon specialising in voice disorders at Wexham Hospital. He also co-authored an influential study during the pandemic on the perceived dangers of aerosols and singing.

2022 was a bad year for hay fever (partly due to the unseasonally warm weather). If a student has hay fever and sounds nasal, is it safe for them to sing?

If someone has general hay fever and stuffiness, I wouldn’t necessarily suggest stopping singing. The concern is if there’s an audible difference in someone’s voice. If the voice has changed in quality or range, that would be the time to think about holding back from singing.

Suppose a singer has difficulty with their range or their voice is husky. In that case, the worry is that the vocal cords themselves are swollen, either because of direct irritation or because this person has been clearing their throat regularly and bashing the vocal cords together.

Should singers with allergies avoid antihistamines?

My general advice for singers with allergies is to avoid taking antihistamine tablets. I try to avoid prescribing antihistamines because they are quite drying, and you then end up with spots of sticky mucus on the vocal folds that can give a crackly sound to the voice.

But also, when the vocal folds are dry, you have to use more energy – more subglottal pressure – to get the vocal folds to vibrate smoothly.

I prefer that someone was on a long-term nasal spray. Different nasal sprays are available, most of which are steroid nasal sprays. Singers get twitchy about using steroids for a good reason. But if you’re on a nasal spray for six or eight weeks over the hay fever season, then in the long term, that will gradually reduce the irritation and swelling in your nose and the amount of mucus produced.

If you take that regularly, it can be very helpful. You can supplement that with an antihistamine as and when you need to.

Is there anything a singer can do to make a cold go away quicker?

The simple answer is no. Colds are viral; they will do what they’re going to do. The viral bit of the cold will probably take a few days to settle down, but then you might be left with a lingering cough, irritation or mucus in the throat that can last weeks.

It is useful to think about hydration, though. Steaming is good as it keeps the mucus nice and soft. And you can take paracetamol if you’ve got a fever. But by and large, you just have to ride it out.

What would you advise a singer who comes down with a cold before a big gig?

The question of whether you can carry on singing if you have a cold is a difficult one. If you’ve got a situation where the voice sounds okay, the range is alright, and there’s no huskiness or breathiness, it probably would be okay to carry on singing.

But if the voice has changed in quality or range, then that implies that the vocal cords are a bit inflamed and irritated. In that situation, if you carry on singing when you’re bashing the vocal cords together with a lot of force, you risk causing some trauma to the vocal cords.

I see patients quite frequently who need to get through one show. If the vocal cords look just a little bit swollen or irritated, there are some medicines that we can provide that will get them through that show.

But if somebody is starting a run of shows that will last several weeks, and their vocal cords are irritated and inflamed, then getting through a huge run will be much more difficult.