#WorldVoiceDay: Are OTC Voice Supplements for Singers Safe and Effective?

John P. Gniady, MD, on behalf of the Voice Committee

John P. Gniady, MDCan any of the sprays, lozenges, or teas marketed to singers help them perform better? Are they safe? As vocal health professionals, we frequently refer to our patients who are professional singers as “vocal athletes.” This is true in many meanings of the term. Athletes are frequently a superstitious lot. Just watch the ritualistic dance of many a professional baseball player stepping up to the plate to bat. Many of our professional athletes are also constantly looking for ways to get ahead with the latest supplement that promises to make them stronger, faster, or more mentally adept. Singers are not immune to either of these tendencies. Like professional athletes, they are under a lot of pressure to perform even in the face of sickness or injury.

The short answer to both questions: maybe. A quick internet search for “singers’ throat remedies” immediately yields easily a dozen different products, many of which appear as sponsored ads, all touting their ability to help improve the singer’s voice. And of course they are “all natural” as well. Natural means they must be good for you, right? The answer here in the United States is doubly complicated.

The claims on all these products are marked with an asterisk that notes: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.” The reason for this is that the United States FDA does not research or regulate herbal supplements in the same way that it does pharmaceuticals. Meaning that we are lacking in research on the safety and efficacy of many of the ingredients in these products. Furthermore, there is no authority in the U.S. ensuring that what the bottle claims to contain is what is in the bottle.

That said, many performers will swear by one product or another and many of these may be somewhat helpful, or at least mostly harmless. There is likely some level of placebo effect, as well. If the batter unstrapping and re-strapping his batting glove three times helps him to hit a home run, who am I to argue? If performers are going to gravitate toward some type of spray, lozenge, or tea, it is most important for them to carefully read the ingredients and know what various products are thought to do. Although many products may contain a “proprietary blend,” it is important to at least examine the claimed ingredients (active and “inactive”).

Most of the sprays and lozenges marketed toward singers contain ingredients meant to lubricate or decrease inflammation. Lubricating sprays tend to contain ingredients like glycerin, aloe vera, or carboxymethylcellulose. They may also contain a variety of salts to make them hypertonic to draw more moisture to the tissues. Lubricating agents are felt to be generally safe, though efficacy is difficult to determine. Ingredients thought to have anti-inflammatory effects include slippery elm, echinacea, osha root, licorice root, and others. These too are generally safe in recommended quantities; however, their anti-inflammatory properties can at times have steroid-like effects, which can lead to elevation in blood pressure, electrolyte abnormalities, and may cause interactions with some other medications.

In general, active ingredients to be avoided include menthol, eucalyptus, and, oftentimes, peppermint. These all have a topical anesthetic effect that, while potentially soothing to the throat, can put a singer at risk of not listening to the body’s natural warning sign of a current or impending injury: pain. Peppermint also has a relaxant effect on the smooth muscle of the esophagus and can therefore worsen acid reflux. Similarly, those at risk for having inflammation or mucus production from acid reflux should use caution making home remedy teas with highly acidic or reflux-inducing ingredients such as vinegar, lemon, peppermint, or hot peppers. It is also a good idea to try to avoid alcohol-based sprays (alcohol will be listed as an “inactive” ingredient) because of alcohol’s irritant effects on the vocal folds.

Although many, if not most, of these specialty products are likely at least safe, the most important lesson for our performers is that they are no substitute for vocal hygiene. Excellent oral hydration is still the best way to lubricate the vocal folds and help to keep mucus thin and light. Keep in mind the saying “pee pale, sing clear.” Cool or warm steam inhalation via a personal steamer, bedside humidifier, or even a hot shower or sauna can also be excellent and safe ways to get more critical moisture to the vocal folds. Performers should remember that pain is likely a warning sign of at least overuse and fatigue and could signal a more concerning injury and therefore should not be ignored or covered up.

Finally, it is best if a performer is going to trial any new product or supplement, that they ideally do that at a non-critical time. Immediately before a performance is not the best time to trial a new remedy without knowing how it may work or any potential side effects it might cause.