Independence of Vocal Load From Vocal Pathology Across Singing Genres.

OBJECTIVE: To investigate the extent to which vocal load is associated with previous diagnosis of a vocal pathology among four major genres of singers (primarily classical, primarily musical theatre (MT), classical and MT combined, and contemporary commercial music only). STUDY DESIGN: Cross sectional survey. METHODS/DESIGN: An anonymous online survey was sent out to about 1000 professional singers through convenience sampling to touring companies, opera companies, MT companies, agents, directors and musical directors. Social media and email were used to solicit participation in the study. We utilized means and standard deviations for continuous characteristics and frequencies and percentages for categorical characteristics and calculated P values to assess whether differences were statistically significant. RESULTS: A total of 396 professional singers completed the survey, yielding a 40% response rate. Nonprofessional singers, incomplete surveys, and respondents <18 years old were excluded, resulting in a total of 238 responses. Among the 238 participants, 32% were performing in the classical style primarily, 33% in the MTstyle primarily, 15% in both classical and MT, and 20% in other contemporary styles only. Mean age was highest among CV + MT and lowest among primarily MT. Combined classical/MT singers were most likely to have a career outside of vocal performance and continue to work in that career followed by other contemporary styles, classical and MT (P = 0.02). Participants in the combined classical/MT group were most likely to have a reported history of vocal pathology followed by classical, other contemporary styles and MT (not statistically significant). However, participants in the contemporary styles were most likely to have a history of more than one type of vocal pathology. Mean vocal load was highest for the MT group. Other nonsinging factors proved significant such as allergy, hydration and acid reflux. Symptoms of allergies were found to be significant across singing genres. A possible reverse causality association was identified in regards to water intake. Participants with acid reflux were three times more likely to have ever reported vocal pathology. CONCLUSION: Vocal load was not significantly associated with vocal pathology across singing genres; however other nonsinging factors such as allergy, reflux and water intake were significantly associated with vocal pathology.

Vocal Fold Pathologies Among Undergraduate Singing Students In Three Different Genres.

OBJECTIVE: This study aimed to compare the prevalence and incidence of vocal fold pathologies among undergraduate classical, musical theatre, and contemporary commercial music (CCM) students over two-time points. METHODS: This study is part of a longitudinal investigation. Videostroboscopic examinations were rated, with consensus among three of four expert blinded raters confirming the presence of pathology. Association between genre of singer and the presence of pathology, interrater reliability, and intra-rater reliability were calculated. Prevalence and incidence of pathologies were compared across genres. RESULTS: During first-year evaluations, 32% of musical theatre, 18% of CCM, and 0% of classical students had vocal pathologies. The prevalence at third-year evaluations showed 22% of classical, 39% of musical theatre, and 27% of CCM participants having vocal fold pathologies. The incidence of pathologies was 67% of musical theatre students compared to 22% of classical students and 27% of CCM students. The four raters demonstrated fair to moderate interrater agreement. Singing Voice Handicap Index-10 scores were normal for CCM singers at both time points but elevated for musical theatre and classical singers. CONCLUSION: No classical singers were found to have pathology during first-year evaluations, although CCM and musical theatre singers showed evidence of vocal fold pathologies. At third-year evaluations, all three genres had an apparent increase in prevalence of pathologies. Implications of this study suggest that more time in the field and intense voice usage may lead to a greater risk of pathology for all singers, regardless of genre. LEVEL OF EVIDENCE: 2 Laryngoscope, 133:2317-2324, 2023.

Associations of Education and Training with Perceived Singing Voice Function Among Professional Singers.

BACKGROUND: The educational backgrounds of professional singers vary greatly and span from no formal training to advanced degrees in music or theater. Consequently, professional singers have a wide range of knowledge regarding basic voice care. The objective of this study was to examine associations between singers' educational backgrounds, specifically their knowledge of vocal pedagogy and awareness of vocal health, and their perceptions of their current vocal function associated with singing. STUDY DESIGN: Cross sectional survey. METHODS: An online survey was distributed nationwide to over 1,000 self-identifying as a professional singer working full time as a performer. The survey included 54 questions about their background education, performance history, years of professional experience, affiliation to a professional union, general health and wellness, and the Evaluation of the Ability to Sing Easily (EASE), a 20-item scale to assess singers' perceptions of the current status of their vocal function. RESULTS: A total of 396 amateur and professional singers completed the survey yielding a 40% response rate. Of 396 surveys received, 154 were excluded because the respondent was not a professional singer and/or the survey was incomplete and four were excluded because the respondent was <19 years old (396-158 = 238). Of 238, 199 completed the EASE (included in this analysis sample). The respondents identified their primary singing genre(s) as follows: 29% classical, 22% musical theatre, 45% both classical and musical theatre, and 5% other contemporary styles. Overall mean (SD, range) Rasch converted EASE score was 19.9 units (9.0, 0-50). Mean EASE score was 19.6 for primary classical, 22.7 for primary musical theatre, 18.4 for both classical and musical theatre, and 23.3 for other contemporary styles (P = 0.03). Participants who were older, had more years of singing training, had a college degree or higher in music, studied classical singing in an academic or private setting, and those who received education in vocal health had significantly lower (better) EASE scores (P-values <0.05). CONCLUSIONS: Professional singers' perception of their current vocal function differed according to their singing genre, age, extent and type of vocal training and vocal health education. Singing teachers, speech-language pathologists, and physicians could use these results to tailor voice education messages to professional singers. This knowledge could help voice care professionals to educate and treat this elite group of voice users to avoid long-term sequelae from suboptimal voice care.

The Role of Observation and Mentorship in Voice Pedagogy Training.

BACKGROUND: Voice teachers are seeking increasing amounts of pedagogical instructions in the form of observerships, coursework, and clinical experiences. Yet to date there has been no formalized attempt to categorize or set guidelines for these educational experiences. OBJECTIVES: The aim of this study was to investigate (a) the number of hours of observations required or electively completed during pedagogical training (voice lessons, masterclasses) and clinical observations; (b) the number of hours of mentorship (critical observation of a student by a mentor) during pedagogical training; and (c) differences in the training backgrounds of voice teachers based on the level of training, position, and genre. METHODS: We distributed a survey to 700 voice teachers (102 respondents) of various levels from private to university and across age range of students. The surveys contained questions about the role of observation in the teacher's training. We ran descriptive analysis and examined whether the proportion of participants with ≥10 observation and mentorship hours was different for classical versus the other musical genres. RESULTS: The number of respondents actively observing and being observed during their training was low. Most observations occurred within the classical and musical theater singing styles. Mentored critical observations of students were lower across genres than student observations, with the majority of respondents (67-92%) reporting no hours in genres other than classical. For all genres except classical, there was a larger percentage of respondents who reported teaching the genre than who reported receiving pedagogical training in the genre. Reported clinical voice observation hours were low (28.4% with ≥10 hours), and few respondents had >0 hours of operating room observation experience (11.8%). CONCLUSIONS: There is wide disparity across genres in the number of hours of observation and critical mentoring, and voice teachers' genre of instruction does not frequently match with the genre of pedagogical instruction they have received. More research is needed to determine the significance of this mismatch and whether increased hours of observation and mentoring would benefit voice instruction.

Prevalence of Vocal Fold Pathologies Among First-Year Singing Students Across Genres.

OBJECTIVES/HYPOTHESIS: The purpose of the study was to compare the prevalence of vocal fold pathologies among first-year singing students from the classical, musical theatre, and contemporary commercial music (CCM) genres. STUDY DESIGN: Prospective cohort study. METHODS: Videostroboscopic examinations were rated by blinded expert raters. Vocal pathology was defined as a vocal fold abnormality on the membranous or cartilaginous portions of the vocal folds or hypomobility. Consensus among three of four raters confirmed presence of pathology. Association between genre of singer and presence of pathology, interrater reliability, and intrarater reliability were calculated. Differences in singing voice handicap, and voice use and vocal hygiene were compared. RESULTS: Fifty-seven participants were included. Seventeen percent of CCM, 40% of musical theatre, and 0% of classical singers were found to have vocal fold pathology. Interrater reliability was 0.522 between all four raters, 0.591 between the two laryngologists, and 0.581 between the two speech-language pathologists, showing a moderate agreement (P < .0001). Intrarater reliability was 1.000 (P < .0001) for the two laryngologists and 0.452 (P = .949) and 0.622 (P = .828) for the two speech-language pathologists. Singing Voice Handicap Index-10 data across genre showed differences between CCM and classical singers. No significant differences were found in voice usage or vocal hygiene. CONCLUSIONS: No classical students were found to have vocal fold pathology, whereas CCM and musical theatre students had significantly higher prevalence of pathologies. Voice use, vocal hygiene, and physiologic phonatory differences among classical, musical theatre, and CCM genres may be risk factors for development of vocal pathology. LEVEL OF EVIDENCE: 2b Laryngoscope, 130: 1996-2002, 2020.

A Review of Training Opportunities for Singing Voice Rehabilitation Specialists.

OBJECTIVES: Training opportunities for singing voice rehabilitation specialists are growing and changing. This is happening despite a lack of agreed-on guidelines or an accredited certification acknowledged by the governing bodies in the fields of speech-language pathology and vocal pedagogy, the American Speech-Language Hearing Association and the National Association of Teachers of Singing, respectively. The roles of the speech-language pathologist, the singing teacher, and the person who bridges this gap, the singing voice rehabilitation specialist, are now becoming better defined and more common among the voice care community. To that end, this article aims to review the current opportunities for training in the field of singing voice rehabilitation. METHODS: A review of available university training programs, private training programs and mentorships, clinical fellowships, professional organizations, conferences, vocal training across genres, and self-study opportunities was conducted. All institutional listings are with permission from program leaders. RESULTS/CONCLUSIONS: Although many avenues are available for training of singing voice rehabilitation specialists, there is no accredited comprehensive training program at this point. This review gathers information on current training opportunities from across various modalities. The listings are not intended to be comprehensive but rather representative of possibilities for interested practitioners.

The economic impact of vocal attrition in public school teachers in Miami-Dade County.

OBJECTIVES/HYPOTHESIS: Teachers are a known at-risk population for voice disorders. The prevalence and risk factors for voice disorders have been well studied in this population, but little is known about the associated economic cost. The purpose of this study is to assess the economic impact of voice dysfunction in teachers and understand the difference between the cost of absenteeism and presenteeism as a direct result of voice dysfunction. STUDY DESIGN: Cross-sectional analysis via self-administered online questionnaire. METHODS: A total of 14,256 public school teachers from Miami-Dade County, Florida, were asked to participate. Questions were formatted based on the previously validated Work Productivity and Activity Impairment: Specific Health Problem questionnaire adapted for hoarseness and voice disorders. Additional demographic questions were included in the questionnaire. RESULTS: A total of 961 questionnaire responses were received. The demographic characteristics of respondents closely matched known statistics for public school teachers in Miami-Dade County. Economic calculations were performed for each questionnaire respondent and summed for all respondents to avoid bias. Per week, absenteeism-related costs were $25,000, whereas presenteeism-related costs were approximately $300,000. These figures were used to extrapolate annual cost. Per year, absenteeism-related costs were $1 million, whereas presenteeism-related costs were approximately $12 million. CONCLUSION: The economic impact of voice dysfunction on the teaching profession is enormous. With the above calculations only including lost wages and decreased productivity, the actual figures may in fact be larger (cost of substitute teachers, impact on nonwork activities, etc.). Research investigating preventative measures for voice dysfunction in teachers is necessary to reduce this costly issue. LEVEL OF EVIDENCE: 2C. Laryngoscope, 126:665-671, 2016.

A Survey of Equipment in the Singing Voice Studio and Its Perceived Effectiveness by Vocologists and Student Singers.

OBJECTIVES: Speech-language pathologists have long used technology for the clinical measurement of the speaking voice, but present research shows that vocal pedagogues and voice students are becoming more accepting of technology in the studio. As a result, the equipment and technology used in singing voice studios by speech-language pathologists and vocal pedagogues are changing. Although guides exist regarding equipment and technology necessary for developing a voice laboratory and private voice studio, there are no data documenting the current implementation of these items and their perceived effectiveness. This study seeks to document current trends in equipment used in voice laboratories and studios. METHODS: Two separate surveys were distributed to 60 vocologists and approximately 300 student singers representative of the general singing student population. The surveys contained questions about the inventory of items found in voice studios and perceived effectiveness of these items. Data were analyzed using descriptive analyses and statistical analyses when applicable. RESULTS/CONCLUSIONS: Twenty-six of 60 potential vocologists responded, and 66 student singers responded. The vocologists reported highly uniform inventories and ratings of studio items. There were wide-ranging differences between the inventories reported by the vocologist and student singer groups. Statistically significant differences between ratings of effectiveness of studio items were found for 11 of the 17 items. In all significant cases, vocologists rated usefulness to be higher than student singers. Although the order of rankings of vocologists and student singers was similar, a much higher percentage of vocologists report the items as being efficient and effective than students. The historically typical studio items, including the keyboard and mirror, were ranked as most effective by both vocologists and student singers.

Acoustic markers to differentiate gender in prepubescent children's speaking and singing voice.

OBJECTIVES: Investigation sought to determine whether there is any acoustic variable to objectively differentiate gender in children with normal voices. METHODS: A total of 30 children, 15 boys and 15 girls, with perceptually normal voices were examined. They were between 7 and 10 years old (mean: 8.1, SD: 0.7 years). Subjects were required to perform the following phonatory tasks: (1) to phonate sustained vowels [a:], [i:], [u:], (2) to read a phonetically balanced text, and (3) to sing a song. Acoustic analysis included long-term average spectrum (LTAS), fundamental frequency (F0), speaking fundamental frequency (SFF), equivalent continuous sound level (Leq), linear predictive code (LPC) to obtain formant frequencies, perturbation measures, harmonic to noise ratio (HNR), and Cepstral peak prominence (CPP). Auditory perceptual analysis was performed by four blinded judges to determine gender. RESULTS: No significant gender-related differences were found for most acoustic variables. Perceptual assessment showed good intra and inter rater reliability for gender. Cepstrum for [a:], alpha ratio in text, shimmer for [i:], F3 in [a:], and F3 in [i:], were the parameters that composed the multivariate logistic regression model to best differentiate male and female children's voices. CONCLUSION: Since perceptual assessment reliably detected gender, it is likely that other acoustic markers (not evaluated in the present study) are able to make clearer gender differences. For example, gender-specific patterns of intonation may be a more accurate feature for differentiating gender in children's voices.

Laryngeal and pharyngeal activity during semioccluded vocal tract postures in subjects diagnosed with hyperfunctional dysphonia.

High vertical laryngeal position (VLP), pharyngeal constriction, and laryngeal compression are common features associated with hyperfunctional voice disorders. The present study aimed to observe the effect on these variables of different semioccluded vocal tract postures in 20 subjects diagnosed with hyperfunctional dysphonia. During observation with flexible endoscope, each participant was asked to produce eight different semioccluded exercises: lip trills, hand-over-mouth technique, phonation into four different tubes, and tube phonation into water using two different depth levels. Participants were required to produce each exercise at three loudness levels: habitual, soft, and loud. To determine the VLP, anterior-to-posterior (A-P) compression, and pharyngeal width, a human evaluation test with three blinded laryngologists was conducted. Judges rated the three endoscopic variables using a five-point Likert scale. An intraclass correlation coefficient to assess intrarater and interrater agreement was performed. A multivariate linear regression model considering VLP, pharyngeal width, and A-P laryngeal compression as outcomes and phonatory tasks and intensity levels as predictive variables were carried out. Correlation analysis between variables was also conducted. Results indicate that all variables differ significantly. Therefore, VLP, A-P constriction, and pharyngeal width changed differently throughout the eight semioccluded postures. All semioccluded techniques produced a lower VLP, narrower aryepiglottic opening, and a wider pharynx than resting position. More prominent changes were obtained with a tube into the water and narrow tube into the air. VLP significantly correlated with pharyngeal width and A-P laryngeal compression. Moreover, pharyngeal width significantly correlated with A-P laryngeal compression.