A Preliminary Study of Vocal Health Among Collegiate A Cappella Singers

ObjectiveCollegiate a cappella groups have grown significantly in popularity and prominence; however, there have been few studies that evaluate the vocal health of this subgroup of young singers. The objective of this preliminary study was to conduct a multiparametric evaluation of the vocal health characteristics of a sample of collegiate a cappella singers. We further tested whether differences in vocal health assessments exist between a cappella singers with and without vocal training and trained collegiate singers who do not participate in a cappella groups.Study designPoint prevalence study.MethodsForty-one collegiate singers participated in this study. Participants were divided into the following three groups: trained singers (TS), trained a cappella singers (ATS), and untrained a cappella singers (AUS). Participants were administered a set of surveys to assess self-perception of singing voice health and perceived access and attitudes toward voice-related health care. Acoustic and laryngoscopic assessments of participant's speaking and singing voice was performed and validated vocal health questionnaires administered as a means to objectively evaluate for the presence of voice problems.ResultsOverall, 87.5% of the ATS and 60% of the AUS groups reported experiencing problems with their singing voice. However, no vocal abnormalities were detected during laryngoscopic and acoustic assessments. Furthermore, minimal differences between any of the measured vocal health parameters were observed between the TS, ATS, and AUS groups.ConclusionCollectively, a high percentage of collegiate a cappella singers with and without vocal training report singing voice problems. However, our sample of a cappella singers did not have increased singing voice problems as compared to vocally trained collegiate singers not in a cappella groups. We did find that a cappella singers may be more inclined to seek information about maintaining a healthy singing voice from their fellow musicians as opposed to singing teachers or other voice health professionals. Singing teachers, otolaryngologists, and speech-language pathologists may need to play a more active role in educating a cappella singers regarding maintaining good vocal health.     

A Pilot Survey of Vocal Health in Young Singers

The objective of this study was to determine the incidence of vocal problems in young choir singers and to correlate vocal problems with demographic and behavioral information. A questionnaire addressing vocal habits and hygiene was offered to 571 young choir singers, up to 25 years of age, who sing at least weekly; 129 (22.6%) responded. More than one-half of the respondents had experienced vocal difficulty, particularly older adolescents. Detrimental behaviors and circumstances surveyed were not reflective of the incidence of vocal difficulty, except for morning hoarseness, chronic fatigue, insomnia, and female gender after puberty. Voice care professionals should be aware that self-reported voice difficulties are common among young choral singers, especially postpubescent girls, and children with symptoms consistent with reflux (morning hoarseness) and emotional stress (insomnia). Laryngologists should communicate with choral conductors and singing teachers to enhance early identification and treatment of children with voice complaints, and to develop choral educational strategies that help decrease their incidence.     

Airway reactivity-induced asthma in singers (Arias)

Professional singers are particularly attuned to changes in air flow that can alter their ability to perform. We describe four singers who complained primarily of performance-related vocalization problems, but who had normal larynges and fundamentally good voice technique. All had normal or near-normal spirometry. Subsequent studies revealed evidence of increased airway reactivity, either by response to bronchodilators or to methacholine. All responded to treatment with bronchodilators with improvement in vocal performance. This represents a form of airway reactivity-induced asthma in singers similar to that found with exercise or hyperventilation.     

Voice Handicap Index in singers

The Voice Handicap Index (VHI) was developed to assess patients' perception of the severity of their voice disorder. The purpose of this study was to determine the degree of handicap expressed by professional and recreational presenters with a voice complaint. Singers (n = 106) and nonsingers (n = 369) with voice symptoms were studied. The results of the VHI for singers indicate that singers score significantly lower (less severe) on the VHI compared to nonsingers. Singers with vocal fold nodules had a lower mean VHI than singers with vocal fold cysts or polyps. Singers who perform classical music had the lowest mean VHI of all types of singers studied. A low VHI in singers may represent a significant handicap and should not be ignored when considering the severity of a singer's voice problem.     

Vocal fold nodules in adult singers: Regional opinions about etiologic factors, career impact, and treatment. A survey of otolaryngologists, speech pathologists, and teachers of singing

This study was undertaken to better understand current regional opinions regarding vocal fold nodules in adult singers. A questionnaire was sent to 298 persons representing the 3 professional groups most involved with the care of singers with vocal nodules: otolaryngologists, speech pathologists, and teachers of singing. The questionnaire queried respondents about their level of experience with this problem, and their beliefs about causative factors, career impact, and optimum treatment. Responses within and between groups were similar, with differences between groups primarily in the magnitude of positive or negative responses, rather than in the polarity of the responses. Prevailing opinions included: recognition of causative factors in both singing and speaking voice practices, optimism about responsiveness to appropriate treatment, enthusiasm for coordinated voice therapy and voice training as first-line treatment, and acceptance of microsurgical management as appropriate treatment if behavioral management fails.     

Prevalence of and Risk Factors for Self-Reported Voice Problems Among Carnatic Singers

BackgroundUnlike Western opera singing, Carnatic singing requires powerful low pitched, loud voice. Singing in the right Shruti or pitch and appropriate breathing is given the main emphasis in this style of music. The present study was conducted to explore the prevalence of and possible risk factors for the self-reported voice problem (VP) in Carnatic singers.MethodThis cross-sectional survey was conducted by distributing the self-reporting questionnaires to 190 Carnatic singers in and around the Mysuru and Bengaluru districts of Karnataka state, India, from December 2016 to April 2017.ResultsThe Carnatic singers were found to have high career (35%) and point (23%) prevalence rates of VP. Clenching of teeth, frequent cold, difficulty in hearing, stress related to the profession, and regular intake of medications for different health-related problems were some of the risk factors found to have a significant association with high prevalence of self-reported VPs. Around 22% of the Carnatic singers missed at least 2–5 singing performances due to VP during their career.ConclusionsOverall, the results of this study reveal a high prevalence rate of self-reported VP in Carnatic singers, and they also suggest that the VPs are associated with different risk factors like any other form of singers. Further studies are needed to understand the effect of VP and to prevent it in this group of professional voice users.     

The Impact of Specific Exertion on the Efficiency and Ease of the Voice: A Pilot Study

Even though most singers and other professional voice users are encouraged to relax to optimize the quality and performance of the voice, observations of acclaimed singers, actors, and public speakers would suggest otherwise. These successful vocal performers appear to be energized, actively working and exerting themselves. For this reason, a study was designed to explore the role of exertion in maintaining and optimizing the voice. The focus of this study was the possibility that increasing exertion could improve the voice and might result in the voice user experiencing less strain and, therefore, more comfort and ease. Ten subjects were recorded before and after completing a workshop to develop their skills with precise use of effort involving selected parameters of the larynx and vocal tract. Self-reported ratings of degree of exertion and level of comfort were collected at the time of each recording. The preworkshop and postworkshop recordings were analyzed acoustically and perceptually to compare the degree of noise in the signal that corresponds with the efficiency of the voice. The results indicated that, for all subjects, the quality of the voice improved with an increase in the use of specific exertion. Furthermore, ease and comfort also significantly increased.     

Development of an Auditory-Perceptual Rating Instrument for the Operatic Singing Voice

Although considerable progress has been made in the development of acoustic and physiological measures of operatic singing voice, there is still no widely accepted objective tool for the evaluation of its multidimensional features. Auditory-perceptual evaluation, therefore, remains an important evaluation method for singing pedagogues, voice scientists, and clinicians who work with opera singers. Few investigators, however, have attempted to develop standard auditory-perceptual tools for evaluation of the operatic voice. This study aimed to pilot test a new auditory-perceptual rating instrument for operatic singing voice. Nine expert teachers of operatic singing used the instrument to rate the singing voices of 21 professional opera chorus artists from a national opera company. The findings showed that the instrument has good face validity, that it can be legitimately treated as a psychometrically sound scale, and that raters can use the scale consistently, both between and within judges. This new instrument, therefore, has the potential to allow opera singers, their teachers, voice care clinicians, and researchers to evaluate the important auditory-perceptual features of operatic voice quality.     

Effect of Hydration and Vocal Rest on the Vocal Fatigue in Amateur Karaoke Singers

Karaoke singing is a very popular entertainment among young people in Asia. It is a leisure singing activity with the singer's voice amplified with special acoustic effects in the backdrop of music. Music video and song captions are shown on television screen to remind the singers during singing. It is not uncommon to find participants singing continuously for four to five hours each time. As most of the karaoke singers have no formal training in singing, these amateur singers are more vulnerable to developing voice problems under these intensive singing activities. This study reports the performance of 20 young amateur singers (10 males and 10 females, aged between 20-25 years) on a series of phonatory function tasks carried out during continuous karaoke singing. Half of the singers were given water to drink and short duration of vocal rests at regular intervals during singing and the other half sang continuously without taking any water or rest. The subjects who were given hydration and vocal rests sang significantly longer than those who did not take any water or rest. The voice quality, as measured by perceptual and acoustic measures, and vocal function, as measured by phonetogram, did not show any significant changes during singing in the subjects who were given water and rest during the singing. However, subjects who sang continuously without drinking water and taking rests showed significant changes in the jitter measure and the highest pitch they could produce during singing. These results suggest that hydration and vocal rests are useful strategies to preserve voice function and quality during karaoke singing. This information is useful educational information for karaoke singers.     

"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.     

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.     

The frequency of hard glottal attacks in patients with muscle tension dysphonia, unilateral benign masses and bilateral benign masses

Hard or abrupt glottal attack (HGA) is one of the vocal behaviors often associated with benign lesion of the vocal folds. This study was designed to determine whether the frequency of HGA was different in hyperfunctional voice patients with and without vocal fold masses. One hundred and forty-seven subjects were studied. All subjects received a complete otolaryngological evaluation including strobovideolaryngoscopy, objective voice measures, and evaluation by a speech-language pathologist. Thirty-two patients were diagnosed with muscle tension dysphonia (19 male, 13 female) without vocal fold masses. Fifty-seven patients were diagnosed with unilateral vocal fold masses (29 male, 28 female), most of which were cysts. Fifty-eight patients were diagnosed with bilateral vocal fold masses (13 male, 45 female). Of the 45 females with bilateral vocal fold masses. 26 had a vocal cyst and reactive nodule and 19 had bilateral vocal fold nodules. The control group was balanced and matched based on sex and on percentage of singers and nonsingers. It consisted of 49 subjects with no vocal fold pathology (20 male, 29 female). The group was composed of professional speakers, singers, and nonprofessional speakers. All voice disordered groups demonstrated higher frequencies of HGA than the control group. Differences were found between the male and female subjects in this study. No differences were found between the various disorders. Differences were also found between the subgroups of bilateral masses, where the bilateral nodules group presented a higher frequency of HGA than the cyst and contralateral reactive nodule.     

The effects of preventive vocal hygiene education on the vocal hygiene habits and perceptual vocal characteristics of training singers

The purpose of the present study was to determine the effects of vocal hygiene education on the vocal hygiene behaviors and perceptual vocal characteristics of untrained singers. Eleven adult untrained singers served as subjects. They attended four 1-hour class sessions on vocal hygiene, including anatomy and physiology of the phonatory mechanism, vocally abusive behaviors, voice disorders commonly seen in singers, and measures to prevent voice disorders. Pre- and postinstruction surveys were used to record subjects' vocal abuses and their perceptions of their speaking and singing voice. They also rated their perceived value of vocal hygiene education. Results revealed minimal changes in vocal hygiene behaviors and perceptual voice characteristics. The subjects did report a high degree of benefit and learning, however.     

Spectral Changes Due to Performance Environment in Singers, Nonsingers, and Actors

From postrecording interviews of professional singers, it was hypothesized that recording environments, i.e., sound-treated environment versus an auditorium, may induce different vocal behaviors. To test this hypothesis, three groups consisting of nonsingers, singers, and actors were recorded in two different recording environments: a sound-treated booth (IAC) and an auditorium (AUD). Three recordings were obtained from each participant: recording one (IAC) and two (AUD1) required the participants to read in a normal voice; recording three (AUD2) required participants to pretend that they were "performing" before a full house. Results indicated that only the singers and the actors exhibited significant spectral and/or frequency/duration differences from one recording environment to another, with the most dramatic differences exhibited by the singers. It was concluded that the environment in which we record experimental samples from professional voice users, especially singers, should be considered as a variable that can affect results.     

Respiratory and glottal efficiency measures in normal classically trained singers

Respiratory and glottal efficiency measures were collected from a pool of 40 classically trained singers with normal larynges. All singers had ?3 years of formal classical voice training and were active professional solo classical singers. Mean flow rates were obtained from all subjects to assess glottal efficiency. Additionally, maximum phonation times and phonation quotients were obtained from a subset of the singers. Pulmonary function test data on forced expiratory volume, forced vital capacity, and forced expiratory flow were obtained for all subjects. Results were compared with published normal values, not specifically derived from trained singers, used commonly in voice laboratoires. Differences were found, suggesting the need for separate normative data to be used for evaluation of the vocal athlete.     

Evaluating the Influence of Warmup on Singing Voice Quality Using Acoustic Measures

Vocal warmup is generally accepted as vital for singing performance. However, only a limited number of studies have evaluated this effect quantitatively. In this study, we evaluated the effect of vocal warmup on voice production, among young female singers, using a set of acoustic parameters. Warmup reduced frequency-perturbation (p < 0.001) and amplitude-perturbation values (p < 0.05). In addition, warmup increased singer's formant amplitude (p < 0.05) and improved noise-to-harmonic ratio (p < 0.05). Tone-matching accuracy, however, was not affected by warmup. The effect of vocal warmup on frequency-perturbation parameters was more evident among mezzo-soprano singers than it was among soprano singers. It was also more evident in the low pitch-range than in the higher pitch-ranges (p < 0.05). The results of this study provide valid support for the advantageous effect of vocal warmup on voice quality and present acoustic analysis as a valuable and sensitive tool for quantifying this effect.     

“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     

MELISMA SINGING AND PREFERRED STAGE ACOUSTICS FOR SINGERS

Vocal performance characteristics, such as tempo, colour, and expressiveness of singers are part of the unique artistic impression of individual performers and individual performances. Subjective pair-comparison studies of singers in a previous study demonstrated that singers prefer added reflections with delays in the range of 10-20 ms. However, the range of values between singers, for the effective duration of the autocorrelation of the singer's voice, was limited, and insufficient to demonstrate a relationship between individual vocal characteristics and the preferred delay time of reflections. In this study, to investigate the singer's preferred acoustics with a change in singing style, subjects were asked to perform non-plosive, non-fricative text for the lyrics, using exclusively “la” syllables (melisma singing). A resulting shift in preferred time delay was observed. The extent of the shift in preferred reflection time delays is shown to be directly related to the minima of the effective duration of the running autocorrelation function calculated from each singer's voice. Singers were also subjected to training, to assist in identifying sound fields. After training, the average preferred delay time of the reflection did not change, but the statistical variability of the singer's subjective rating of the sound fields was strongly reduced.     

The relationship between measured vibrato characteristics and perception in Western operatic singing

This study examined the association between acoustic and perceptual data related to vibrato in Western operatic singing using recordings of performances by internationally famous opera singers. Three related studies were conducted. Study 1 used commercial recordings of the same five singers and the same cadenza examined by Siegwart and Scherer(1), measured vibrato rate and extent in each singer's performance of the cadenza and tested possible associations between these vibrato attributes and judges' preference for singers. Studies 2 and 3, using recordings of different internationally famous singers and a different cadenza, measured vibrato onset, rate, and extent in each singer's performance of the cadenza, required judges to rank the singers in order of personal preference, to identify the emotion expressed, and to assess the degree of success in communicating emotion achieved by the singer. The findings showed that the perception of the singers' vibrato did not always agree with acoustic measurements. However, a comparison of the acoustic measurements with the preference and emotion judgments suggest that some elements of vibrato may affect listeners' perception of the voice, their preference for a particular singer, and assist the communication of emotion between singer and audience.