November 8th, 2012 | by Anthony F. Jahn

Endless Phlegm!

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

Dr. Jahn welcomes your questions. You can send these to editor@voicecouncil.com

This discussion is for general information and not to be construed as specific medical advice that you should obtain from your own physician.

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  • MusicDirector

    The student might have a bit of an intestinal yeast problem, which creates more phlegm. I used to have this problem and did an anti candida diet and an anti-candida program (Yeast busters) and it helped a lot.

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  • Anonymous

    Maybe the student secretly smokes weed. I know when I smoke pot it tends to create ungodly amounts of phlegm, exacerbated by air pollution. If so the only answer is to stop. Takes months for the lungs to fully clear.

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  • http://www.facebook.com/poppa.madison Poppa Madison

    I am no medic, so I pass on what I know with no qualification other than that it worked for me when I had or have excessive phlegm or mucous problems that affect my talking…..let alone my singing.
    Those who like me suffer from Hay fever will likely readily relate to the quandary.
    I found the use of a spray inhalant of 3% Hydrogen Peroxide to be beneficial in reducing phlegmatic congestion.
    More about this can be found at:-

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  • http://www.facebook.com/poppa.madison Poppa Madison

    OK……..so I am back!

    But then I am for what I feel is good reason to share my experience of today. How one writes up on such things as medical issues can be judged unsavoury or even disgusting so I will get to the point and avoid the nasties!

    Dawn today saw me rise with …shall we say a feeling of chestiness. However I neither felt the urge nor the real need to go to great lengths over the bathroom basin to clear myself of it.

    Little did I know that relief would come for me at precisely 3.30pm when my daughter and family dropped in for a late lunch of freshly prepared CRAB CURRY.

    After a hearty meal of it, all those natural herbs and spices went to work, and boy if I was was expecting something I was not quite expectorating what I did.

    It was the Curry! That delicious CRAB curry had worked to invoke natures own best response to phlegmatic lungs.

    It was an encore of expectoration that left me at the same time, shocked, yet thrilled and momentarily exhausted.

    So there you have it! The remedy for phlegmatic congestion as never revealed for the benefit of so many of my peers.

    If you have “Endless phlegm”, end your malady. Get your girlfriend, your wife, your Mum, your Granny……………..get ANYBODY!…. to make you a “Heaps Chilli Hot” Crab Curry.
    And once again …Breath Easy!

    Poppa ( cough! cough! choke! choke!……whooh!…’Scuse me!)

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  • Poppa Madison

    For quite some years now I have had a major problem with this. I feel certain that the cause is Hay Fever caused by the pollens from the plants and Tropical grasses that grow in Queensland Australia, where I reside.

    I am reluctant to keep dosing myself with Anti-histamine concoctions as I already have to take a few prescribed medicines since having had open heart surgery just over a year ago.

    When I lived in the UK (where I was born) I never had Hay Fever. It was not until I got into my first Australian summer that the ailment showed up with a vengeance. So much so, that when I was on a camping holiday with my two young sons in 1974, I was almost falling asleep on my feet and losing so much fluid nasally and optically that I had to seek help at a Pharmacy in Cooma, a place we had planned to just pass through.

    I can never forget what happened next. The Chemist took one look at me and said, I think, a few Hail Mary’s, then handed me a little white pill.

    “Go and find somewhere where you can sleep and take this tablet!” were his parting words to me. It will make you sleep. It WILL MAKE YOU SLEEP! ”

    There was an ominous insistence in his tone.

    I took the boys to an off-road camping spot outside the town and set up the tent. I felt as if I had the most terrible influenza. It was about 4pm in the afternoon. Sipping water from my camping water bottle, I downed the tablet. Then I zipped up the tent and instructed my boys not under any circumstances to wander off anywhere. Then everything went blank as if I had been anaesthetized!

    When I awoke, it was 7.30am ! I could remember nothing. However, I felt good and was able to rise and face the day. My boys told me they had not left the tent since I closed it!

    Whatever was in that pill hit that Hay Fever like a tank going through a battlefield and I was able to continue with the holiday.

    Poppa

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