• Drink, swig, sip and slurp water. Juices or herbal teas are okay too, but recall that drinks with caffeine dehydrate instead of rehydrate. Most physicians recommend 32 ounces per day as a minimum - 64 ounces is better.
• In case you missed it in the earlier point, it's best to limit caffeine. At the very least, if you can't give up coffee, teas or Mountain Dew, realize that you need to replace the fluids you've lost. For example, if you drink a mug of coffee, re-fill it with water and drink it all. Also, increase your caffeine know-how.
• If your home or working environment is dry, consider investing in a humidifier. A good rule of thumb is to keep your environmental surroundings at 30 percent humidity or higher.
• Many over-the-counter cold and flu medications contain agents that dehydrate mucus membranes. While this may alleviate some of your cold symptoms, they also may dehydrate the vocal folds. Use these medications judiciously. Also, be aware that some pain relievers such as Excedrin and Anacin contain caffeine. Check their labels.
• Alcoholic drinks also dehydrate the body. If you choose to use alcohol, replenish your body's hydration level by drinking extra water.
• Some prescribed medications can also dehydrate the body and the vocal folds. Check the NCVS Prescribed Medications and Their Effects on Voice and Speech to see if your medication may be having an adverse effect on your vocal system.
• Occasionally, expectorants such as Robitussin, can be used to thin the body's mucus.

Colds, Sore Throats and Laryngitis
Often when these viral bugs get you down, your vocal folds become swollen. You may notice this will make your voice deeper, huskier or hoarse. It is important to treat your voice with some extra care when these illnesses occur.

• Shush. This may be rudely stated, but at least we got your attention. Sometimes the novelty of having a "new voice" due to changes in the vocal folds makes it tempting to chat. But it is important to remember that during your illness, your vocal tissues are especially vulnerable to damage. Limit talking to bare essentials. Use paper and pencil or e-mail to get your messages across. When you do need to talk, do so softly and avoid shouting or screaming.
• Avoid throat clearing - this action is damaging to the delicate vocal fold tissues. Try sipping water instead to clear mucus.
• While you're in the "vocal caution zone", take more extreme measures to increase hydration.
  • Gargle with warm salt water. [Some vocologists advise adding a pinch of baking soda to the solution.]
  • Use the salt water to gently clean the nasal passages, if necessary.
  • Gently inhale steam. Boil plain water in a pot, remove from the stove, and put your face in the rising steam. [Take care not to scald your skin by leaning too close to the hot water.] Tent a towel over your head to keep the steam from dissipating.

Fatigue
Investigators hypothesize that two distinct types of vocal fatigue occur: muscle fatigue and tissue fatigue. Muscular fatigue happens when the muscles of the vocal system are over-used, just as muscles in the other parts of the body ache when they are over-used with strenuous exercise. Tissue fatigue, however, is caused by excessive destruction of the cells composing vocal fold tissues.

Persons with vocal fatigue may be able to discern which type they are experiencing with close attention to symptomology. Muscular fatigue is often described as a tight or sharp pain in a diffuse area of the throat. Tissue fatigue, on the other hand, is likely to be a raw or sore feeling in a more localized area - right behind the Adam's Apple.

So is this distinction important? After all, isn't vocal fatigue vocal fatigue? Not surprisingly, because the cause of these two types of fatigue differs, recommendations for alleviating problems also differs.

Persons with muscular fatigue would likely benefit from working with a vocologist. The vocologist can demonstrate special exercises that will strengthen the muscles used for talking. Other common-sense approaches such as reducing muscle tension during speaking or improving breath support may also be helpful. New research is underway to determine if periods of talking, followed by periods of vocal rest - even as short as 10 minutes - will alleviate the daily toll on vocal musculature.

Those with tissue fatigue would likely benefit from improving vocal hygiene (increasing the body's hydration level, using good breath support and removing vocal irritants). Learning to use the voice more healthfully and efficiently - with the assistance of a vocologist - may also be helpful.

Have you read or heard that those with vocal fatigue should not whisper and wondered why this was so? Whispering is soft talking without the vibration of the vocal folds. Thus, if a person has muscular vocal fatigue, whispering would not allow the muscles to rest and would be of no benefit.

Reflux Disease and Voice
Acid reflux is the spill-over of stomach acids into the larynx, which can damage the tissues. Some voice specialists believe gastro-esophageal reflux disease (GERD) is a significant contributor to many voice problems. It may be signaled by a sour taste in the mouth or heartburn-like symptoms. Be aware, however, that GERD may be present without symptoms. Some people need surgery or prescribed medication for their GERD. Others benefit by simply implementing new habits:

• Do not eat nor drink alcohol within 2-3 hours of sleeping.
• Limit irritating foods such as coffee, chocolate, spicy or fatty foods, carbonated drinks, and alcohol.
• Quit smoking.
• Try to eat moderate amounts of food at a time, rather than taking in daily calories in just one or two meals.
• Avoid clothing that is tight around the waist, such as snug belts or tight jeans.
• Remain upright right after eating.
• Elevate your head with extra pillows or raise the head of your bed on blocks so that you aren't lying completely flat when you sleep.
• Acid-reducing agents, such as Pepcid AC, are now available as over-the-counter medications.
• See your physician if symptoms continue.

• When should you seek help of a professional? More than two weeks of hoarseness or voice changes should be checked by a physician. Nearly all viral illnesses resolve within this time period. Chronic pain with speaking should always be investigated.
• Singers should avoid aspirin products at all times. This includes any anti-inflammatory drug such as Aleve, Motrin, Advil, aspirin, etc. Vitamin E should be used in moderation. These agents thin the blood and predispose one to sustain a vocal fold hemorrhage, particularly if coupled with excessive voice use or with improper voice use. Tylenol (acetaminophen) is acceptable.
• Smoking is detrimental to vocal fold tissues. It also limits a person's ability to breathe deeply to provide good support for speaking. Worse yet, smoking is the leading cause of laryngeal cancer. Smoking marijuana may be even more devasting to the voice - as much as 20 times worse than cigarettes.
• Are you one of those individuals who "carries tension" in the shoulders and throat area? Over-tensing of these muscles can impact your voice. Try gently stretching shoulder and neck muscles periodically throughout the day.
• Simply be aware of background noise. Trying to be heard over loud music, noisy motors or others' conversations may cause you to over-tax your vocal system. Seek quiet areas or physically move closer to the person(s) with whom you are speaking.