Can anything be done to avoid such viruses?

The influenza vaccine offered each fall does not protect against all common colds or flu viruses. The vaccine is based on the previous year's most virulent influenza virus strains. Unfortunately, new viral strains keep arising for which you have no acquired immunity. The virus spreads rapidly throughout the community by airborne and hand transmission of nasal and throat secretions. The only way to diminish transmission of the virus is for infected individuals to wear protective masks and gloves. In reality, it is not possible to isolate oneself completely from the many viral epidemics which ravage our community. Frequent hand washing and avoidance of close personal contact with individuals affected by the common cold can minimize the chances of catching the disease.

Homeopathic medicines claim to improve one's immunity. If homeopathic medicines have any benefit it seems to be on the long term and not when symptoms have already manifested themselves. The same can be said for vitamins and mineral supplements. Traditional medicine still maintains that proper nutrition, adequate daily rest and minimizing negative stress in our lives, does more for the immune system than any so-called remedies. Hormonal and metabolic disorders (such as diabetes or anemia) may make you more susceptible to catching the cold or flu viruses and weaken your ability to combat the disease.

I keep catching one cold after another! What is wrong with me?

Beware. What you believe to be recurrent colds may actually be exacerbations of chronic sinonasal infections. Allergies are a common underlying cause. Allergies will cause swelling of the lining of the nose and sinuses and favour the development of infection. Anatomical deformities of the nose and sinuses such as deviations of the nasal septum, often lead to mechanical obstruction of the sinus openings and narrowing of the nasal passageways. The added swelling of the nasal lining by the cold virus simply favours the retention of secretions of the sinuses. Other disorders of the nasal turbinates (those special filters within our nose) that also lead to protracted upper respiratory tract infections. Two to three common colds a year may be acceptable, particularly if you travel a lot. Anymore than that deserves a proper medical evaluation (including special radiographic imaging of the nose and sinuses) to seek underlying precipitating factors.

I caught a cold and I have a recital tomorrow. Should I cancel?

Once the virus has infected lining of the respiratory tract nothing much can be done to halt it's progression. Medications, old folk remedies, traditional or alternative medicines, all have palliative rather than curative effects. Nevertheless, they can hasten the resolution of symptoms and prevent sinonasal or pulmonary complications such as sinusitis or pneumonia. The ability to perform vocally while suffering from a cold has more to do with the overall respiratory status than actual infection on the vocal cords. There are times when the vocal cords may be capable of singing through the tenacious mucus but there is no point in pursuing this task when the body is ill. Denying yourself time to recover only lengthens the illness.

Cancelling a performance because of a bad cold or the flu requires professionalism. Fainting on stage or collapsing after a performance or in the middle of a tour, will win you empathy but will reflect poorly on your judgement. Having said that, I admit that physicians are no better than singers and other professionals when acknowledging one's limits. We are all guilty of pushing our bodies beyond the limits when there is a duty to perform. Your laryngologist will understand your mindset when it comes to making a decision to perform with a cold or the flu. A strict contraindication to singing would be the presence of significant swelling or hemorrhage of the vocal cords. In my experience, this is a rare finding. More often than not, it is the presence of sinonasal infection and a productive cough as well as generalized malaise which will justify the need for vocal rest. The singer may have already decided to cancel a performance but needs the formal support of the laryngologist to convince the manager and to avoid financial penalties.

I have a cold. What should I do?

The principles of therapy are to decongest (decrease the swelling of the glands and lining of the respiratory tract) and humidify. This will favour the expectoration of secretions, improve nasal breathing and decrease coughing. A multitude of over-the-counter medications are available for this purpose. You should avoid medications which have drying side-effects (such as some anti histamines). While they give temporary relief from a running nose, with repeated use they tend to make secretions more tenacious and difficult to expel. Look for medications that are pure decongestants (such as pseudoephedrine). Some formulations also include an analgesic/anti-inflammatory (such as acetaminophen) to the decongestant to relieve headaches and fever. Stick to medications which contain a single or few ingredients. It will be easier to match the medications to your symptoms and minimize side-effects. If decongestant medications leave you feeling jittery and unable to sleep (as if you have had too much coffee) try taking a long acting (12 hour) preparation early in the morning and none at night, or decrease the recommended dosage by half.

In addition to decongestant pills, you may use decongestant nasal sprays (xylometazoline) for the rapid relief of nasal obstruction (particularly before sleep). Do not use these nasal sprays beyond the recommended daily frequency and do not use more than five days in a row. Saline nasal sprays, on the other hand, are innocuous and beneficial to most nasal disorders. Generous vaporisations of the nasal passageways with saline (four to five times a day, five vaporisations each nostril) is beneficial when the nasal secretions are thick and purulent or when the nose feels dry and stuffy. Seek the advice of your pharmacist in choosing medications which are compatible with your metabolism and meet your needs.

Humidifying the ambient air and drinking plenty of fluids are well known precautions taken by professional singers. In the absence of a humidifier, lock yourself into the bathroom, run the shower to stream up the room while you drink a litre of mineral water. You will not be cured by this ritual but you will have given your body the means to detoxify itself. Ultimately, everyone finds their own remedy and ritual which works for them. You will find that independent of the remedies used, the three "R"'s principles prevails; Resign yourself to Rest and Recover.

The benefits of vocal rest and total body rest are underestimated. Returning the vocal organ to it's most primitive function of respiration is the goal. It is during quiet respiration that the laryngeal biomechanics are the most efficient. Forcing the larynx into phonation when the biomechanics are not optimal calls for misuse of the laryngeal muscles. Quite unbeknownst to the inexperienced singer, patterns of laryngeal muscular tension will rapidly set in and remain even after the infection has passed.

Can a cold damage my vocal cords?

Upper respiratory tract viral infections rarely cause serious damage to the vocal cords. The vocal cords will develop some swelling and will be weighted down by tenacious secretions. The degree of vocal disability is usually out of proportion to the degree of vocal swelling. In other words, you may sound terrible (or have no voice at all!) yet the vocal cords don't look that bad. Coughing may bring worry that the vocal cords are being damaged. In fact, coughing is a normal physiological reflexive function aimed at protecting the lower respiratory tract from further infection. A productive cough which expels secretions from the trachea should be assisted by the use of expectorant medication (guaifenisin) and lots of humidification and hydration. It is the dry spasmodic cough which seems to originate from a tickle in the throat which has the potential to strain the larynx. A cough which interferes with sleep and impairs easy breathing should be suppressed by dextromethorphan or codeine elixir. A protracted cough beyond 7 days, requires medical evaluation to rule out bronchitis, pneumonia or asthma. It is not unusual for the trachea and bronchus to retain a heightened sensitivity to irritants while recovering from an infection.

Don't singers with colds deserve antibiotics?

Antibiotics will do nothing for the common cold. Unfortunately, they are prescribed by physicians succumbing to patient's incessant demands. Antibiotics are not as innocuous a believed. They can cause serious side-effects including allergic reactions to colitis (inflammation of the bowel). It is best to reserve antibiotics for the treatment of complications of the common cold such as sinusitis or tonsillitis or pneumonia. It is true that respiratory tract infections that are initially of viral origin may be complicated by bacterial infections. It takes a thorough physical examination and clinical judgement (often substantiated by radiological investigations) to decide upon the need for antibiotic therapy. Antibiotic therapy at the onset of a cold will not prevent complications from occurring and will not shorten the duration of the illness.

While recovering from a cold when can I start singing?

If your cold did not affect the quality of your speaking voice, you may return to singing within 48 hours of the acute phase of the illness. If your speaking voice is hoarse, maintain voice rest as much as possible and reassess on a daily basis. Gentle humming within your vocal range and deep breathing exercises will help clear tracheal secretions and re-establish breath control and the pneumophonetic association. When recovering from dysphonia, keep the total daily voicing to 4 hours non-continuous. Progressively increase to 6 and 8 hours a day of voicing paying particular attention to your "break-point" ( the point at which you start experiencing vocal fatigue). Do not push your voice beyond your break-point. If you have not recovered full vocal efficiency within ten days of the onset of your cold, a laryngeal examination is warranted to further guide your rehabilitation.

Fortunately, the common cold and the flu are self-limiting infections, which resolve in 7 to 10 days. For the singer and vocal performer, full recovery may take 2 to 3 weeks, which seems like an eternity when singing is your raison d'etre. The near future will likely bring vaccination and antiviral medications to rid society of these common viral infections which encroach on our quality of life.

Doctor Francoise P. Chagnon is Montreal born and educated and received her medical degree from McGill University in 1981. She specializes in Otolaryngology and head and neck surgery. In 1993, as a travelling fellow of the Royal College of Surgeons of Canada, she perfected her subspecialty interest in laryngology and the professional voice at the Vanderbilt University Voice Center. She is currently assistant professor of Otolaryngology at McGill University and Director of the Voice Laboratory at the Montreal General Hospital. She is a certified laser surgeon and a member of many professional societies, including the Canadian, American and British Voice Foundations, and the American College of Surgeons. She lectures frequently to voice students and professionals.

The Montreal General Hospital / McGill University Voice Laboratory is a diagnostic, research and teaching endeavor of McGill University's Department of Otolaryngology. The Voice Lab houses specialized equipment to study the human voice and its disorders. This equipment includes digital audiovisual laryngostroboscopic examinations and sound spectrography. The Voice Lab caters to all individuals presenting with voice and throat disorders as well as providing expertise to singers and professional voice users. The Voice Lab is staffed by a multidisciplinary team consisting of technicians, speech-language pathologists, voice scientists and laryngologists. Appointments are given upon referral at the following number 514-937-6011, ext. 2285. For further information, please contact Doctor Francoise P. Chagnon at the same number or fax your inquiries to 514-934-8200.

Ask the Throat Doctor

Do you have any specific questions for Dr. Chagnon about the voice or vocal ailments? Submit them to Ask the Throat Doctor c/o La Scena Vocale, 5411 Waverly, Montreal, Quebec, H2T 2X8, or by email at chanw@ere.umontreal.ca

Does Echinacea help cure the common cold?

Not according to a study reported in the February 25th broadcast of the CBC TV show Marketplace. - WKC