From the WebMD Archives

Jan. 3, 2019 -- It’s sore throat season. While most of us muddle through with lozenges and hot tea, for others, the season is a threat to their livelihood. People who literally sing for their supper -- or act, podcast, or speak -- haven’t got time for the pain.

“Video game recordings are extremely strenuous,” says Chris Tergliafera, the voice behind the villainous Ultron Sigma in the video game “Marvel vs. Capcom: Infinite.” “You have to yell, attack, and die in a multitude of ways -- being burned alive, stabbed.” So, he can’t die of a sore throat.

Tergliafera, like most vocal professionals, doesn’t let a sore throat stop him from working. Here’s what the pros do when they’ve got to push through.

When Your Throat Is in Flames

When Tergliafera stepped into the recording booth to voice Ultron Sigma, he found a bottle of Nin Jiom Pei Pa Koa, or more simply Pei Pa Koa throat syrup. “The director explained that the actor who voiced the Hulk had been in the booth before me and used this syrup before any of his loud roars,” he recalls. They dubbed the syrup “Hulk Juice,” and Tergliafera gives it all the credit for getting him through 3- to 4-hour yelling sessions.

The active ingredient in the Chinese syrup is slippery elm bark, a common homeopathic remedy for sore throat.

“It’s all anecdotal, but I think [slippery elm] is thought to be anti-inflammatory,” says Gaelyn Garrett, MD, an otolaryngologist and senior executive director of the Vanderbilt Voice Center at Vanderbilt University Medical Center in Nashville.

The National Library of Medicine says slippery elm bark is “possibly effective” for sore throat. It may be a natural painkiller. Using scientific evidence, the Library of Medicine rates how well many homeopathic remedies work, using the terms “effective,” “likely effective,” “possibly effective,” “possibly ineffective,” “likely ineffective,” “ineffective,” or “insufficient evidence to rate.”

Read the label carefully on the bottle of Pei Pa Koa. Some newer versions may omit the elm bark. Other herbal cough and throat syrups contain slippery elm bark. So do some lozenges and Throat Coat tea, a favorite among vocal professionals.

When Acid Is to Blame

Many pro talkers and singers swear by ginger in various forms.

“Ginger ale soothes and cools a sore throat,” says voice-over artist Will Johnson, who co-hosts AARP’s “Perfect Scam” podcast with famous scammer Frank Abagnale (the subject of the movie Catch Me If You Can).

Opera singer Jennifer Holloway agrees. “For soothing and bringing down swelling, the best concoction is ginger tea,” she says. Last year, the singer performed 30 operas in cities all over Europe, Asia, and the Americas. “As most singers know, you don’t sing the job, you don’t get paid, so we all do what we have to do,” she says.

What Holloway does when she has a sore throat is “peel and cut up an entire knob of ginger. Boil it for 15 to 20 minutes, then pour the elixir through a strainer and add honey and lemon. Turmeric is also great in that concoction,” she says.

Voice actor Christy Fabbri also swears by a brew of ginger, honey, and lemon to help maintain the voice that has extolled the virtues of Rice Krispies Treats, Skechers Stretch-Knits, and Downy Wrinkle Releaser Plus in TV commercials. “It really helps me bring my voice back,” she says.

When the potion contains many elements, such as honey, lemon, and hot water, there’s really no telling which one (if any) is having an effect, Garrett says. Hulk Juice is based in a honey syrup and contains ginger and other herbs. One of those herbs, loquat, is also a common ingredient in herbal throat syrups, lozenges, and drops.

“If there are two or three things that a person is using to help a particular problem, it’s probably not an evidence-based treatment,” says Garrett. “There’s probably a lot of placebo effect in these things, which I’m OK with as long as it’s not causing harm.”

As for ginger, there’s some evidence that the root can settle an upset stomach, but there’s no conclusive evidence that shows it relieves any other maladies. “If acid reflux is the cause of the sore throat, ginger ale has been shown to settle a queasy stomach, but I think reflux is way over-diagnosed as the cause of throat or voice problems and lets us overlook whatever the real cause may be,” says Garrett.

When Phlegm Builds Up

Honey, says Johnson of “A Perfect Scam,” is “nature’s cough drop.” Singers and speakers like the way it soothes and coats the throat. There could be something to that. The National Institutes of Health says it’s a homeopathic cough suppressant.

“Some theories suggest that it can affect consistency of mucus,” says Garrett. “You want mucus to be as watery thin as possible.”

You might also keep mucus from getting too thick by laying off of dairy. “Stay away from dairy and alcohol, and drink plenty of water,” says singer-songwriter Michelle Malone, “to hydrate the throat and thin mucus.” All of these, Garrett says, can help break down mucus.

Staying hydrated is key, and that could be the simple secret behind the teas that everyone drinks to soothe a sore throat: They hydrate. “Have water with you at all times, and sip on it all day long,” says Garrett, “and if lemon helps you drink water, then I am all for it.”

Vocal pros go for hydration in all forms. Many prefer steam. “I put my face over a steaming bowl of hot water with a towel over my head for a makeshift steaming tent,” says Fabbri. Holloway, the opera singer, uses a handheld steam inhaler, to which she adds a little chamomile. Others just soak up the steam from a hot shower.

When a Scratchy Throat Needs S(m)oothing

Alcohol, on the other hand, dehydrates, says Garrett, whose location and area of expertise mean she works with a slew of country singers. “There are some old singers still around and doing quite well who swear by a swig of whiskey before they go onstage. Now there’s probably not enough alcohol in a swig that they’re getting dehydrated. They’re probably doing it for the relaxation of that performance anxiety and the throat coating.”

That’s why Tergliafera loves honey-based Pei Pa Koa syrup, aka Hulk Juice. “It’s soothing and coats the throat so that you don’t put as much strain on your vocal cords.”

Another throat coater that Garrett says the country singers hang their hats on -- “We’ve heard it more than once: Eat a bag of greasy potato chips before you perform. I think they feel that the grease coats the throat.”

Though you probably won’t find scientific research to support the therapeutic benefits of a heavy dose of greasy potato chips, and certainly not a steady diet of them, Garrett says that’s OK. “People know what they like. Even if you ask a physician what they like to do for certain ailments, I think you’ll find that a lot of us will quote certain nonproven home remedies. If it works for you, and there’s no harm, I am fine with it.”

Show Sources

Gaelyn Garrett, MD, senior executive director, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville.

Chris Tergliafera, voice actor, Los Angeles.

Will Johnson, co-host, “A Perfect Scam” podcast, Tacoma Park, MD.

Jennifer Holloway, opera singer, Bethlehem, GA.

Christy Fabbri, voice actor, Winnipeg, Manitoba.

Michelle Malone, singer-songwriter, Atlanta.

National Library of Medicine DailyMed: “Nin Jiom Pei Pa Koa.”

Natural Medicines Comprehensive Database: “Slippery elm.”

National Center for Complementary and Integrative Health: “Flu and colds,” “The Common Cold and Complementary Health Approaches: What the Science Says,” “Ginger.”

MedlinePlus: “Slippery Elm.”

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