The Happy Larynx: Caring For Your Voice With Vocal Health, Part 1: Hydration

All systems in the body have medical recommendations for how to best care for them. We need fiber, protein, and carbs for our digestive system, good sleep for our brain, and exercise for our muscles and joints. The larynx is no different! Caring for the health of our throat and larynx provide a helpful foundation for maintaining vocal consistency and function for daily voice use.

You can access our free vocal health handout here.

Hydration WORKS!

We’ll start with the simplest, and arguably most important tissue health factor for your larynx: hydrate, hydrate, hydrate! As W. Auden said, “Thousands have lived without love, but not one without water”. Drinking enough daily water keeps the tissue of our vocal folds and throat slippery and moist, which is the optimum environment for the vocal folds to vibrate without extra effort. Several studies have been conducted that show decreased hydration makes it harder for the vocal folds to vibrate, which can result in changes to vocal quality and ease of voice production (1). Additionally, being constantly dehydrated makes it harder for your vocal folds to heal from the daily impact we put on them, and can make it easier to develop lesions (2).

So, what are the best ways to hydrate? Systemic hydration is the process of orally or intravenously ingesting water, and is the foundation for achieving quality daily hydration. The U.S. National Academies of Sciences, Engineering, and Medicine recommends drinking between 11-15 cups (about 90-120 oz) a day of water (3). Topical hydration is an alternative to drinking water that puts water directly onto the vocal folds, and can include either or both steaming and nebulizing.

Topical Hydration with Steaming and Nebulizing

Steaming: Steaming includes inhaling steam from fresh water directly into the lungs (which passes over the vocal folds), either with a device such as a personal steam inhaler (seen below), or by inhaling steam from a water source. Daily steaming for 15+ minutes has been shown to improve clarity and quality of the voice (measures called “noise to harmonic ratio”, jitter, and shimmer). The steamer seen below can be purchased here. Avoid using this steamer with menthol inserts, as these can be drying.

Nebulizing: Nebulizing is the process of inhaling isotonic saline (fluid that is perfectly balanced with our cellular makeup) directly into the larynx and lungs. A machine breaks the particles down into a microscopic size, so that they can cross the cellular barriers easier. Nebulizing should only be done after speaking with a physician, and only with isotonic saline (for voice purposes). You can find isotonic saline here. The saline solution is put into a device such as the one below. Studies show that nebulizing 1x/day for 15+ minutes reduces the voice’s “phonation threshold pressure” (how much airflow you need to start your voice) better than steaming (2). You can purchase the nebulizer seen below here.

Caffeine and alcohol

While it has been established that caffeine has a diuretic (and therefore dehydrating) effect when consumed above 300mg, a recent study showed that this did not have the same dehydrating impact on the vocal folds (4). However, the study specifies that more research is needed, with larger sample sizes. Alcohol is also a diuretic and causes dehydration and lowered inhibition (which reduces awareness of vocal use). So, a good rule of thumb is always to supplement caffeine and alcohol with increased systemic hydration.

Menthol

Menthol is a chemical that is naturally found in peppermint and other mint plants, but can be made in a lab. It was initially discovered as an analgesic (pain reducer) and muscle relaxer, and was added to cigarettes in the 1920s to reduce irritation caused by nicotine (this actually resulted in a higher addiction rate to cigarettes and led to a higher prevalence of progressive lung disease, due to the masking effects of the chemicals) (5). Menthol stimulates and then desensitizes our pain receptors, which provides a cooling effect when applied topically (6). When used during or post-illness, the effect of menthol can provide desired relief from sore throats and extra mucus. However, the drying effect of menthol has a detrimental impact to tissue hydration in the long-term. It can also begin to cause irritation for people with chronic cough and throat clearing behaviors (laryngeal hypersensitivity). There are specific cough drops that do not contain menthol, some of which include:

• Halls Breezers

• Fontus

• Luden’s Cherry

• Grether’s Pastilles

You can also suck on hard candy (not peppermint). Always check the ingredients on the back of the packaging for menthol. The flavoring of a cough drop is not a clear indicator for whether the product has menthol.

Conclusion

Both systemic and topical hydration are helpful and important tools a person can implement to decrease their risk of vocal injury, and increase their voice’s reliability and quality. A person is recommended to drink between 11-15 cups (80-120 oz) of water per day (systemic hydration), and can supplement their hydration with either steam inhalation with fresh water, and/or nebulizing with isotonic saline (topical hydration). Caffeine and alcohol should be limited and supplemented with increased systemic hydration. Menthol should not be used in the long-term.

Sources

1) van Wyk, L., Cloete, M., Hattingh, D., van der Linde, J., & Geertsema, S. (2017). The effect of hydration on the voice quality of future professional vocal performers. Journal of Voice, 31(1), 111-e29.

2) Venkatraman, A., Hawkins, J., McCain, R., Duan, C., Cannes do Nascimento, N., Cox, A., & Sivasankar, M. P. (2022). The role of systemic dehydration in vocal fold healing: Preliminary findings. Laryngoscope Investigative Otolaryngology.

3) Mayo Foundation for Medical Education and Research. (2022, October 12). How much water do you need to stay healthy?. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256#:~:text=The%20U.S.%20National%20Academies%20of,fluids%20a%20day%20for%20women

4)  Erickson-Levendoski, E., & Sivasankar, M. (2011). Investigating the effects of caffeine on phonation. Journal of Voice, 25(5), e215-e219.

5) Association, A. L. (n.d.). What is Menthol?. American Lung Association. https://www.lung.org/quit-smoking/smoking-facts/health-effects/what-is-menthol#:~:text=Menthol%20is%20a%20chemical%20naturally,and%20the%20irritation%20from%20nicotine.

6) Pergolizzi JV Jr, Taylor R Jr, LeQuang JA, Raffa RB; NEMA Research Group. The role and mechanism of action of menthol in topical analgesic products. J Clin Pharm Ther. 2018 Jun;43(3):313-319. doi: 10.1111/jcpt.12679. Epub 2018 Mar 10. PMID: 29524352.

7) Tanner, K., Roy, N., Merrill, R. M., & Elstad, M. (2007). The effects of three nebulized osmotic agents in the dry larynx.

Written by Brittani Farrell, MS CF-SLP, MM, BME

See the “Happy Larynx” series for other articles on vocal health. You can also download a simple, vocal health handout here.

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