Nebulize is On the Rise: Saline for Optimal Vocal Hydration?


Any voice user knows that when there’s vocal trouble from crazy schedules, different venues, demanding vocal tasks and even airplane travel, we will try anything to get things better. We’ve tried special tea, lozenges, and even gargling with salt water or ginger. Are any of these treatments actually beneficial? We know that low humidity, breathing through our mouths, breathing during exercise, smoking and using inhalers can all contribute to dryness of the vocal cords (Tanner at al 2015) so Kristine Tanner and her colleagues wanted to find out if hydration could be proven to actually help the voice.


Hydration can help the vocal folds because it regulates internal and external vocal cord fluid (Tanner et al 2015) helping the vocal fold cells stay healthy. Why do we care? Because dehydration can cause stiff vocal cords and increased pressure below the vocal cords during sound production, potentially resulting in hoarseness, vocal fatigue, vocal effort and coughing (Tanner et al 2015). There are two types of hydration, and the first is systemic hydration, or the water we drink. This type of hydration is found in food and liquids, and reaches the tissue internally, but does not directly reach the vocal cords. What if we could put hydration on the vocal folds like we put lotion on our skin or topically? Inhaling nebulized 0.9% isotonic saline can actually put that lotion on its skin… or else we get the hose again. Just kidding.


Multiple studies have looked at nebulizing isonic saline to improve surface hydration, and it all started with Verdolini Abbott and her colleagues back in 1990 when they observed phonation threshold pressure in individuals who had dehydrated vocal cord tissues. Roy and Sivasankar and Fisher were also paramount at continuing this look into how hydration affects our vocal cords. Findings of studies were that nebuilizing isotonic saline can help in the short term length of time with lubrication of the voice box.

Nebulizing isotonic saline improves voice production (acoustically) and vocal effort (patient survey) and symptoms of dryness. Studies recommend small particle nebulizers for this purpose because they require low airflow rates while the moisture is delivered to the vocal cords (Tanner et al 2015).


Because there is a possibility of lung complications in people who have underlying health conditions, it’s always best to consult with your physician if you begin any nebulized isotonic saline routine. Physicians can help you determine the best route of administration, as well as the frequency and dosage amounts.


You can get a prescription from you physician, but you may need to obtain the nebulizer and the saline from different locations in my experience. You can order each on Amazon as well, and there are many different sizes of nebulizers to choose from, as well as brands of the sterile saline bullets. Companies also package the set of tools together.

One way to provide this is through the My Vocal Mist package. Click here for an affiliate link to order this for your very own. (Full Disclosure, there is a percentage of this link that will help support our endeavors with The Confident Clinician Cooperative financially.) This is an affiliate link, but the research is clear. Thanks for reading.

It works great when you are in dry conditions like on an airplane and you expect to use your voice after you land. Any professional voice user should talk with their health care provider to see if this is a recommended option for you.


Tanner, K., Nissen, S. L., Merrill, R. M., Miner, A., Channell, R. W., Miller, K. L., … Roy, N. (2015). Nebulized isotonic saline improves voice production in Sjögren’s syndrome. The Laryngoscope, 125(10), 2333–2340. doi:10.1002/lary.25239

Tanner, K., Roy, N., Merrill, R. M., Muntz, F., Houtz, D. R., Sauder, C., … Wright-Costa, J. (2010). Nebulized Isotonic Saline Versus Water Following a Laryngeal Desiccation Challenge in Classically Trained Sopranos. Journal of Speech Language and Hearing Research, 53(6), 1555. doi:10.1044/1092-4388(2010/09-0249)

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on voice science nationally. She is part of the Professional Development Committee for ASHA Special Interest Group 3, Voice and Upper Airway Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at She has developed a line of voice specific therapy materials for kids and adults on TPT or her website. Follow her on Pinterest, on Instagram or like her on Facebook. Also check out what she and her partners are building at

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