“Alternative medical therapy” use among singers: Prevalence and implications for the medical care of the singer

Singers are extremely conscious of health problems that affect their voices and well-being and often take an active role in seeking care for these problems. They frequently seek treatment from providers or with modalities considered “alternative” to traditional medical care. A survey of singers was completed to elucidate their attitudes and practices regarding “alternative modalities” of medical care. Frequently singers will self-medicate or take advice from people not well versed in the special needs of a professional voice user. They will fail to share this information with the physician when seeking “traditional” medical care. These practices may predispose the singer to suboptimal or even dangerous care. These results are discussed, as well as the implications for the medical physician treating the singer. The possible detrimental pharmacologic effects of “natural therapies” widely used by singers are presented, with special attention to the particular concerns for the professional singer     

“Compensatory falsetto”: Effects on vocal quality

The term “compensatory falsetto”, for the purpose of this investigation, refers to the development of an abnormally high-pitched voice in the presence of laryngeal pathology where more socially acceptable lower pitched voice production is possible. The purpose of this investigation was to compare laryngeal compensations and their effects on objective measures of vocal function during production of compensatory falsetto voice. Eighteen patients with abnormally high-pitched voice in the presence of underlying laryngeal pathology were evaluated in the Department of Otolaryngology at the University of Miami School of Medicine from January 1988 through December 1992 and were diagnosed with “compensatory falsetto”. Vocal fold paralysis (n = 11) was the most common laryngeal pathology. Vibratory characteristics were evaluated through videostrobolaryngoscopic examination. Acoustic and aerodynamic parameters assessed included fundamental frequency, jitter rate, harmonic-to-noise ratio, glottal air flow, and maximum phonation time. Production of a higher-pitched voice appeared to improve glottic closure and decrease the amount of air loss during phonation. A corresponding increase in maximum phonation time and improvement in acoustic characteristics of jitter and harmonic-to-noise ratio was also observed.     

Self-reported voice problems among three groups of professional singers

A vocal health questionnaire was administered to three groups of professional singers and a “friendship-matched” group of nonsingers in Melbourne, Australia. The responses of 79 opera, 57 musical theatre and 31 contemporary (excluding rock) singers and 86 nonsingers were analysed. The questionnaire solicited information regarding biographical data speaking and singing voice-use behaviours, and vocal health over the previous 12 months in terms of experiences of vocal impairment, vocal disability, and handicap. Significant differences between singers and nonsingers in the prevalence and nature of voice problems were reported. Of the singers, 44% reported one or more occurrences of a diagnosed vocal condition compared to 21% of nonsingers and 69% of singers experienced vocal disability compared to only 41% of nonsingers, over the previous 12 months. In contrast, no significant differences were found between the three different styles of singers in their experience of vocal impairment, disability or handicap.     

Airway Considerations for Professional Singers—A Survey of Expert Opinion

The objective of this study was to survey physician experts in voice disorders/treatment to establish consensus guidelines for translaryngeal intubation (TLI) and tracheotomy when treating professional singers or other voice professionals. A written survey was sent to all physician members of the Voice Foundation seeking opinions/recommendations about route of TLI, duration of TLI before tracheotomy, size of endotracheal and tracheotomy tubes, and special interventions during patient care as these might differ between professional singers and nonsingers. Fifty-five percent of the physicians responded, of whom 73% classified their experience in voice care as “extensive.” A strong consensus (76%) favored a smaller endotracheal tube for singers (6–7 mm I.D. for males and 6.0 mm I.D. for females) via the oral (46%) versus nasal (36%) route. Intubation/extubation by the most expert/experienced personnel was emphasized so as to minimize direct trauma to the larynx. While intubated, strong recommendations were made to suppress gastric acid production and to minimize motion of the endotracheal tube, including patient sedation. Preferences for an early tracheotomy (6 days) versus their usual time (10 days) were approximately equal (44% vs. 50%, respectively) and most respondents (69%) recommended the same size tracheotomy tube (8.0 mm I.D. for males and 6.0 mm I.D. for females) for singers and nonsingers. Post extubation/decannulation care emphasized voice rest, retraining, continued gastric acid suppression, and the possibility of direct laryngoscopy to assess post-TLI or tracheotomy injuries.     

Comparisons of pharynx, source, formant, and pressure characteristics in operatic and musical theatre singing

Belting, a vocal technique typically cultivated in musical theatre singing, differs timbrally from operatic singing in many interesting respects. The underlying phonatory differences have not been previously investigated in detail. Yet, belting is frequently associated with disturbances of voice function. Articulatory and phonatory characteristics are investigated in a female subject who is a professional singer (co-author JL) trained in both the operatic and belting styles and in an intermediate vocal technique (“mixed”). This article presents data obtained from this subject by video-fiberoptic observation of the pharynx, inverse filtering of airflow, and measurement of subglottal pressure. The results reveal that belting was characterized by very high subglottal pressures and sound levels, and apparently also by a comparatively high degree of glottal adduction. Comparisons with other investigations of related aspects of belting and operatic singing support the assumption that the data obtained from our subject are representative for these vocal techniques.     

Effects of Testosterone Replacement on a Male Professional Singer

Testosterone has been known to play an important role in the development of the postpubertal male voice for many centuries. In fact, the prevention of pubertal development of the voice by castrating young male singers was a well-known practice, especially in Italy beginning in the sixteenth century. The “castrati” were well known for their clear, high-pitched voices. Because of the resulting small larynx and vocal folds, castrati apparently produced a distinctive resonance as well as the high pitch, which cannot be matched even by the counter tenors of today. Busy voice labs occasionally see males with sex hormone deficiencies secondary to chromosomal or gonadal problems. This is a presentation of an unusual patient who was a trained tenor singer and was found to have hypogonadism on a premarital health examination. Administration of replacement testosterone resulted in significant vocal register and voice quality changes.     

What is “Twang”?

A single female professional vocal artist and pedagogue sang examples of “twang” and neutral voice quality, which a panel of experts classified, in almost complete agreement with the singer's intentions. Subglottal pressure was measured as the oral pressure during the occlusion during the syllable /pae/. This pressure tended to be higher in “twang,” whereas the sound pressure level (SPL) was invariably higher. Voice source properties and formant frequencies were analyzed by inverse filtering. In “twang,” as compared with neutral, the closed quotient was greater, the pulse amplitude and the fundamental were weaker, and the normalized amplitude tended to be lower, whereas formants 1 and 2 were higher and 3 and 5 were lower. The formant differences, which appeared to be the main cause of the SPL differences, were more important than the source differences for the perception of “twanginess.” As resonatory effects occur independently of the voice source, the formant frequencies in “twang” may reflect a vocal strategy that is advantageous from the point of view of vocal hygiene.     

Completeness of “good” Bethe ansatz solutions of a quantum-group-invariant Heisenberg model

The sl_q(2) quantum-group-invariant Heisenberg model with open boundary conditions is investigated by means of the Bethe ansatz. As is well known, quantum groups for q equal to a root of unity possess a finite number of “good” representations with non-zero q-dimension and “bad” ones with vanishing q-dimension. Correspondingly, the state space of an invariant Heisenberg chain decomposes into “good” and “bad” states. A “good” state may be described by a path of only “good” representations. It is shown that the “good” states are given by all “good” Bethe ansatz solutions with roots restricted to the first periodicity strip, i.e. only positive-parity strings (in the language of Takahashi) are allowed. Applying Bethe's string-counting technique completeness of the “good” Bethe states is proven, i.e. the same number of states is found as the number of all restricted paths on the sl_q(2) Bratteli diagram. It is the first time that a “completeness” proof for an anisotropic quantum-invariant reduced Heisenberg model is performed.     

The association between upper trapezius activity and thorax movement in classical singing

This study aimed to examine in classical singing the phasing of the activity in upper trapezius (TR) to upper and lower thorax movement and to the phasing of activity in the intercostals (INT) and in the lateral abdominal (OBL) muscles. Electromyographic (EMG) activity was recorded from the TR, INT, and OBL muscles on the right side. Thorax movement (TX) was traced with two strain gauge sensors placed around the upper and lower thorax. Four professional opera singers (soprano, mezzo, tenor, and baritone) and four advanced student classical singers (three sopranos and one mezzo) participated. Three of the professional singers were 33 years, and one was 40 years. The students were between 23 and 30 years. Different arias, freely chosen by the singers from their professional repertoire, served as the singing task for the opera singers. All students sang “Summertime” from Porgy and Bess. All subjects performed their task three times with variation in vocal loudness (normal, forte, piano). Thereafter, for all subjects, a biofeedback (BF) procedure was performed on TR to lower TR activity and a repeat performance of the singing tasks was carried out. EMG activity from the three recording sites and upper and lower TX circumference were compared before and after BF. A phasing of upper TR activity to INT and OBL activity was discovered, all muscles supporting the expiration phase. During phonation, the upper TR contributes in the compression of upper TX, thus serving as an accessory muscle of expiration. Group results from both opera singers and student singers showed that EMG activity was significantly lowered after BF. The lowered TR activity resulted in an expanded upper TX circumference and less TX respiratory movement after BF.     

Nuclear track radiography of “Hot” aerosol particles

Nuclear track radiography was applied to identify aerosol “hot” particles which contain elements of nuclear fuel and fallout after Chernobyl NPP accident. For the determination of the content of transuranium elements in radioactive aerosols the measurement of the -activity of “hot” particles by SSNTD was used in this work, as well as radiography of fission fragments formed as a result of the reactions (n,f) and (γ,f) in the irradiation of aerosol filters by thermal neutrons and high energy gamma quanta. The technique allowed the sizes and alpha-activity of “hot” particles to be determined without extracting them from the filter, as well as the determination of the uranium content and its enrichment by ²³⁵U, ²³⁹Pu and ²⁴¹Pu isotopes. Sensitivity of determination of alpha activity by fission method is 5×10⁻⁶ Bq per particle. The software for the system of image analysis was created. It ensured the identification of track clusters on an optical image of the SSNTD surface obtained through a video camera and the determination of size and activity of “hot” particles.     

Supraglottic contribution to voice quality

Although there has been continuing interest in voice quality, much of this research has focused on the vocal folds rather than the supraglottal structures. This paper reports the use of videoendoscopy for studying supraglottal participation in various singing tasks. In a preliminary study presented last year by the present authors, CT scanning was used to corroborate videoendoscopic observation. Vocal tract activities observed included variation of laryngeal height with pitch, variation of pharyngeal wall dimension with pitch and vowel, and marked supraglottic constriction with certain vocal imitations. In order to gain a better understanding of vocal training, and its effect upon vocal tract physiology, a study was designed using videoendoscopy to observe singers with significant experience and training while performing various vocal tasks. The tasks focused on the following: (1) vocal tract activity associated with pitch changes; (2) the physiology involved in the production of “cover”; (3) the structures involved in the production of vibrato; and (4) the physiology of the singer's “ring.” It would appear that videoendoscopy will become increasingly more valuable to the voice community as our understanding of vocal tract physiology improves.     

Learning voice analysis using an interactive multi-media package: Development and preliminary evaluation

An important outcome of education for speech-language pathologypractice is the ability to analyze voices perceptually, a complex task that is often difficult for novices. This article describes an interactive multi-media package, “A Sound Judgement,” that is designed to help students develop skills in perceptual voice analysis and to link their perceptions to laryngeal physiology. The package presents a range of clients with vocal impairments at increasing levels of complexity. Each case has a videoed interview, endoscopic views and animations of the larynx, and case history information. Students make perceptual ratings of clients' voices on a format designed specifically for this package and feedback is provided using ratings made by expert speech-language pathologists. High levels of consensus for the perceptual judgments were achieved among the expert raters. Preliminary evaluations by students have demonstrated that “A Sound Judgement” is likely to be a valuable educational tool.     

Speaking fundamental frequency characteristics as a function of age and professional singing

The purposes of this project were to discover (1) if the speaking fundamental frequency (SFF) levels of professional singers differ significantly from those of nonsingers and (2) if the age-related SFF patterns are similar for these two classes of individuals. Sixty professional singers and 94 nonsingers were recorded reading the first paragraph of the “Rainbow Passage;” both males and females were included. Three paired groups (young, middle, and old age) were studied; they were selected on the basis of health and age. The professional singer groups were further divided by a binary voice classification system, specifically that of soprano/alto for women and tenor/baritone for men. It was found that the sopranos and tenors exhibited significantly higher SFF levels then did the age-matched nonsingers, whereas the altos and baritones did not differ significantly from the controls. Relationships within the performer groups were mixed. For example, there appeared to be a systemic trend for the sopranos and tenors to exhibit higher SFF levels than the altos and baritones. Finally, although the nonsinger SFF levels varied significantly as a function of age, those for the professional singers did not.     

Functional Characteristics of a New Electrolarynx “Evada” Having a Force Sensing Resistor Sensor

Electrolarynxes have been used as one of the rehabilitation methods for laryngectomees. Earlier electrolarynxes could not alter frequency and intensity simultaneously during conversation. Recently, we developed an electrolarynx named “Evada” (prototype so far) using a force sensing resistor (FSR) sensor that can control both frequency and intensity simultaneously during conversation. Employing three types of electrolarynxes (Evada, Servox-inton, Nu-vois), this study was undertaken to examine the functional characteristics of Evada for the normal control group and for laryngectomess. Five laryngectomees and five normal adults were asked to express three sentences (declarative sentence, “You stay here.”, interrogative sentence, “You stay here?”, and imperative sentence, “You! Stay here.”) using three types of electrolarynxes. Frequency and intensity changes between the first and last vowels in the three sentences were calculated and analyzed statistically by paired t test. The frequency changes in the interrogative and imperative sentences were more prominent in Evada than in Servox-inton and Nu-vois. The intensity changes in the interrogative and imperative sentences were also more prominent in Evada than in Servox-inton and Nu-vois. Evada controls frequency and/or intensity by having the subject press the control button(s). Therefore, Evada appears to be better at producing intonation and contrastive stress than Nu-vois and Servox-inton.     

Belting and pop, nonclassical approaches to the female middle voice: Some preliminary considerations

There is a commonly perceived difference in the sound produced in the approximate range D₄-D₅ by female singers in the western opera and concert tradition, on the one hand, and certain other styles, including rock, pop, folk, and some Broadway musicals, on the other. The term “belting” is sometimes used to refer to at least one approach to such “nonclassical” singing. In this study, based on spectrographic, electroglottographic, and sub- and supraglottal pressure measurements on representative voices of the “operatic” and “nonclassical” tradition, acoustic and laryngeal differences between the two traditions are described, and an objective, specific definition of “belting” is offered.     

Laryngeal adduction in resonant voice

The primary question in this study was whether subjects with nodules and subjects with healthy larynges would produce “resonant voice” with a similar laryngeal configuration. A second question regarded whether the electroglottographic closed quotient (EGG CQ) could be used to noninvasively distinguish resonant from other voice types. Twelve adult singers and actors served as subjects, including 6 persons with healthy larynges and 6 persons with nodules. Performers were used as an attempt to maximize token validity and stability. Subjects produced repeated tokens of resonant, pressed, normal, and breathy voice during sustained vowels. Laryngeal adduction was directly estimated using blinded, ordinal, visual-perceptual ratings based on videoscopic views of the larynx. EGG CQs were further calculated based on separate trials. The perceptual ratings indicated that subjects in both groups produced resonant voice with a barely adducted or barely abducted laryngeal configuration that was distinct from configurations for pressed and breathy (but not normal) voice. Previous literature suggests that this configuration may be relevant in many cases of voice therapy (I). Average CQs distinguished resonant from pressed voice, but inconsistently distinguished resonant from breathy voice. Further CQs were reliably different across healthy subjects and subjects with nodules. Thus, the utility of this measure to noninvasively estimate resonant voice may be limited, particularly without ongoing subject-specific calibration procedures.     

Optical aperture synthesis using successive exposure of a single photograph and spatial-filtering “low-frequency redundancy” suppression

A high-resolution “full spatial-frequency range” optical image may be synthesized by superposing in a single plate a suitable set of low-resolution partial frequency-range photographs, obtained separately or simultaneously, with “low-frequency redundancy” suppressed by spatial filtering.     

On “diagonal” Bianchi cosmologies

A list of the possible “diagonal” Bianchi cosmologies is given, with a proof that it is complete.     

Singing power ratio: Quantitative evaluation of singing voice quality

This paper presents a parameter for objectively evaluating singing voice quality. Power spectrum of vowel sound / a / was analyzed by Fast Fourier Transform. The greatest harmonics peak between 2 and 4 kHz and the greatest harmonics peak between 0 and 2 kHz were identified. Power ratio of these peaks, termed singing power ratio (SPR), was calculated in 37 singers and 20 nonsingers. SPR of sung / a / in singers was significantly greater than in nonsingers. In singers, SPR of sung / a / was significantly greater than that of spoken / a /. By digital signal processing, power spectrum of sung / a / was varied, and the processed sounds were perceptually analyzed. SPR had a significant relationship with perceptual scores of “ringing” quality. SPR provides an important quantitative measurement for evaluating singing voice quality for all voice types, including soprano.