Steaming: Will It Burn My Vocal Folds And Cause A Vocal Fold Haemorrhage?

Steaming: Will It Burn My Vocal Folds And Cause A Vocal Fold Haemorrhage?

– By Elle Holiday

My singing teacher told me that steaming right before singing is bad and will cause a vocal fold injury, is that true?

To fully comment and advise on the impact of steam on the tissues in the throat, we first need to understand the science behind thermal dynamics, the cooling and heating mechanisms of the body and the evidence presented around steam and injuries to the larynx. So, let’s have a look!


How the Airway Cools Inhaled Steam or Hot Air

  1. Airway Structure and Function: The human respiratory system is designed to condition the air we breathe. The nasal passages, sinuses, and upper respiratory tract (URT: includes the pharynx and larynx) play crucial roles in this process.

  2. Heat Exchange: When steam or hot air is inhaled through either the nose or mouth, it comes into contact with the moist mucosal lining of the URT (the URT is anything about the level of the vocal folds). This lining is highly vascular, meaning it has a rich supply of blood vessels close to the surface. The blood in these vessels absorbs heat from the inhaled air, effectively cooling it down.

  3. Evaporation and Humidification: The mucosal surfaces in the URT also secrete moisture, which helps in humidifying the incoming air. As the hot air or steam passes through, this moisture evaporates, absorbing a significant amount of heat in the process. This is similar to how sweating cools the body.

  4. Temperature Gradient: There is a temperature gradient from the external environment to the lower parts of the respiratory tract. As the inhaled air moves deeper into the respiratory system, the temperature continues to drop, ensuring that by the time it reaches the lower airways and vocal folds, it is closer to body temperature.


Addressing Singers’ Concerns About Steam Inhalation

Why Steam Inhalation is Generally Safe:

  • Gradual Cooling: The mechanisms described above ensure that steam or hot air is cooled effectively before reaching the vocal folds. The risk of burning the vocal folds under normal circumstances is minimal because the air temperature is significantly reduced as it travels through the upper respiratory tract.
  • Moisturising Effect: Steam can be beneficial in keeping the vocal folds hydrated and soothing any irritation, as the warm, moist air helps to maintain mucosal moisture.

Situations of Risk:

  • Explosive Combustion: The only significant documented and proven risk of burning the vocal folds comes from inhaling steam in scenarios involving explosive combustion around 130°C, or when the steam is under high pressure. In such cases, the volume and velocity of the steam may overwhelm the cooling mechanisms of the respiratory system. Eg: If a pressurised steam pipe explodes and someone is in close proximity to inhale it.

  • High-Pressure Inhalation: Inhaling steam suddenly and forcefully (e.g., during a gasp) can also pose a risk, as the cooling process might not be sufficient to prevent thermal injury.


Breathing Through the Mouth vs. Nose

  1. Nasal Breathing: The nasal passages are specifically designed to filter, humidify, and warm or cool the air we breathe. The large surface area and the presence of turbinates (bony structures) in the nose increase the contact time between the air and the mucosal lining, enhancing the cooling effect.

  2. Mouth Breathing: When breathing through the mouth, the air bypasses the nasal passages and goes directly into the pharynx and larynx. Although the mouth also has a mucosal lining that can cool the air to some extent, it is less efficient than the nose. The cooling effect is still present but reduced, meaning the air might not be as well-conditioned as it would be through nasal breathing.


Risk of Vocal Fold Hemorrhage Post-Steam Inhalation

Evidence and Recommendations:

  • Vocal Fold Condition: There is no direct evidence to suggest that singing immediately after inhaling steam increases the risk of vocal fold hemorrhage. However, the warm, moist environment created by steam inhalation can cause the vocal folds to be more pliable, so some people prefer to allow a short period of rest after steam inhalation before engaging in strenuous vocal activities like singing. However, there is no current evidence that suggests either waiting or not waiting poses any more or less risk either way.


Practical Advice for Safe Steam Inhalation:

  • Moderate Temperature: Ensure the steam is at a comfortable, moderate temperature. It should feel warm but not hot. The safest temperature according to the most recent steam inhalation studies by Ichiba et. al (2019) and Solihin, S. (2023), appears to be within the range of 38°C to 44°C (100.4°F to 111.2°F). This range is effective in providing therapeutic benefits while minimising the risk of other adverse effects.

  • Controlled Inhalation: Inhale the steam gently and steadily, avoiding sudden gasps or inhalations that might draw in too much hot air too quickly.

  • Distance from Source: Maintain a safe distance from the steam source to prevent exposure to excessively hot steam.


Conclusion

Inhaled steam is effectively cooled by the body’s natural processes before it reaches the vocal folds, whether breathing through the nose or mouth, though nasal breathing is more effective. The only documented cases that pose a significant risk to burning the vocal folds comes from scenarios involving explosive combustion or high-pressure steam inhalation. Currently, there is no direct evidence linking steam inhalation to increased risk of vocal fold hemorrhage.


Want to try steaming for yourself?

Discover the benefits of steaming for your voice through VocaLab. We stock the popular Bosistos Steam Inhaler (shipping to Australia only) for you to use to help hydrate your vocal cords topically, thin out thickened mucus and reduce vocal strain. Whether you’re a professional singer or just love to sing, steaming can enhance your vocal performance.



If you are a singing teacher and learnt something new from this one VocaLab blog post today, imagine what else you will learn in our 5-week signature Singing Teacher Training Course – The Vocal Educator Toolkit (VET)!

This holistic, evidence-based course is designed to empower and improve your effectiveness as a vocal teacher. Enhance your singing teaching skills with our CPD-accredited online course that integrates Speech Pathology practices and singing techniques. CLICK HERE to learn more about the VET and join a global community of vocal educators.


References

Balakrishnan, K., Wiegand, H., Kumar, M., & Kratz, M. (1996). Burns and inhalation injury caused by steam. Burns, 22(5), 313-315. https://www.sciencedirect.com/science/article/abs/pii/0305417995001379

Gerosa, M., & Kenny, C. (2022). The effects of vocal loading and steam inhalation on acoustic, aerodynamic and vocal tract discomfort measures in adults. Journal of Voice.

Holm, S., Engström, O., Melander, M., Horvath, M. C., Fredén, F., Lipcsey, M., & Huss, F. (2022). Cutaneous steam burns and steam inhalation injuries: A literature review and a case presentation. European Journal of Plastic Surgery45(6), 881-896.

Ichiba, T., Kakiuchi, K., Suzuki, M., & Uchiyama, M. (2019). Warm steam inhalation before bedtime improved sleep quality in adult men. Evidence-Based Complementary and Alternative Medicine, 2019, 1-7. https://doi.org/10.1155/2019/2453483

Solihin, S. (2023). Implementation of simple inhalation steam therapy in children with upper respiratory tract infection. Indonesian Journal of Community Development, 3(2), 92-98. https://ejournal.upi.edu/index.php/IJCD

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