Patient Profiling: Determining the Effects of Patient Factors on Vocal Fatigue

OBJECTIVES

The phenomenon of vocal fatigue and the types of patients that are at greatest risk for vocal fatigue are not fully understood. The goal was to investigate patient profiles such as voice disorder type, demographics (age and gender), singing identity, interoceptive awareness, and psychosocial impacts on the severity of vocal fatigue.

STUDY DESIGN

Prospective cohort study.

METHODS

Ninety-five subjects with voice disorders were asked to complete Part 1 of the Vocal Fatigue Index (VFI-Part1), the Voice Handicap Index-10 (VHI-10), and the Multidimensional Assessment of Interoceptive Awareness, version 2 (MAIA-2). The effects of voice disorder type (structural, neurological, functional), psychosocial impact, age, gender, self-reported singing identity, and interoceptive awareness on self-perceived vocal fatigue (VFI-Part1) were determined using multivariate linear regression.

RESULTS

Vocal fatigue had a significant psychosocial impact on patients with voice disorders, as measured by the VHI-10 (P < 0.001). However, there were no significant effects of vocal fatigue across any of the three voice disorder types (P's >0.05). Age (P = 0.220), gender (P = 0.430), and self-identified singing experience (P = 0.360) also did not have significant effects on vocal fatigue. Additionally, there were no significant relationships between interoceptive awareness MAIA-2 sum scores (P = 0.056) or any of the MAIA-2 sub-scores (P's > 0.05) and vocal fatigue severity (VFI-Part1).

CONCLUSION

Vocal fatigue has a significant psychosocial impact on patients with voice disorders. However, patient profiles, including voice disorder type, patient age, gender, singing identity, and level of interoceptive awareness do not appear to play a major role in vocal fatigue symptom reporting. These findings suggest caution should be exercised when attributing patient profiles to vocal fatigue presentation and severity. Studying pathophysiological mechanisms underlying vocal fatigue may help better distinguish unconscious bias in patient profiling from the etiology and severity of vocal fatigue.

The Relationship Between the Stomatognathic System and Voice in Classical Singers

PURPOSE

To evaluate stomatognathic system's structures and functions in classical singers, relating them to the auditory-perceptual judgment of voice quality and voice self-perception.

METHODS

A cross-sectional pilot study was conducted to evaluate the Stomatognathic System (SS) using orofacial myofunctional evaluation (MBGR Protocol). Voice handicap self-perception was assessed by the Classical Singing Handicap Index (CSHI) and the Voice Handicap Index (VHI-10). Voice samples, recorded according to the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol, underwent auditory-perceptual judgment by two voice experts. All statistical analyses adopted a 5% significance level.

RESULTS

The study included 15 classical singers (nine women and six men). Adequate assessments of lip and tongue functionality and mobility, upper and lower lip, mentum, and tongue tone were higher compared with altered assessments (P < 0.001). Nasal and oronasal breathing showed similar proportions among singers (P = 0.273). Participants reported greater pain in the masseter muscle (P ≤ 0.001), temporomandibular joint (TMJ) (P ≤ 0.001), and sternocleidomastoid muscle (SCM), especially on the left side (P ≤ 0.001). MBGR score showed no association with singers' voice handicap and voice quality self-perception.

CONCLUSION

MBGR-evaluated SS items were not related to auditory-perceptual judgment of voice quality and voice self-perception. Singers reported more pain with palpation in the SCM, masseter muscle, and TMJ. Preference for a chewing side was higher than bilateral chewing. Assessing SS is paramount for the multidimensional evaluation of classical singers' voice.

Dysphonia and Throat Clearing in Singers During the COVID-19 Pandemic in Brazil

OBJECTIVE

The COVID-19 pandemic in Brazil affected the lives of singers, with negative impacts of the disease on the voice, such as dysphonia and throat clearing. This study aims to evaluate the presence of dysphonia and throat clearing in singers during the COVID-19 pandemic in Brazil.

MATERIAL AND METHODS

This is a cross-sectional analytical study with a sample of 154 singers from all over Brazil. Data collection was carried out online, by completing the questionnaire created by the researcher using Google Forms. The following were considered the outcome variables: voice impairment and throat clearing. The bivariate analysis was performed to test the relationship between COVID-19 infection and voice impairment, COVID-19 infection and throat clearing, COVID-19 infection and laryngeal complaints (voice impairment and throat clearing).

RESULTS

In this study, the mean age of the singers was 35.8 (Standard deviation = ±10.2 years) and 59.2% were female. Most of them worked as professional singers (81.1%) and had more than 10 years of professional experience (57.4%), mainly singing pop music (85.4%). A total of 62% reported vocal alterations during the COVID-19 infection and 53% had vocal alterations after the infection, with 44.0% reporting the onset of throat clearing after the infection. There was a significant association between COVID-19 infection and having voice impairment (P = 0.03; prevalence ratio - PR: 2.33; CI: 1.04-5.46). An association was observed between the onset of throat clearing and the occurrence of COVID-19 infection (P = 0.001; PR: 9.13; CI: 2.47-64.42).

CONCLUSIONS

The results indicated that there is an association between COVID-19 infection and complaints of dysphonia and throat clearing in Brazilian singers. This study demonstrates the importance of guidance to singers infected with COVID-19 by health voice processionals.

Vocal Vibrato Characteristics in Historical and Contemporary Opera, Operetta, and Schlager

OBJECTIVES/HYPOTHESIS

Vibrato is a core aesthetic element in singing. It varies considerably by both genre and era. Though studied extensively in Western classical singing over the years, there is a dearth of studies on vibrato in contemporary commercial music. In addressing this research gap, the objective of this study was to find and investigate common crossover song material from the opera, operetta, and Schlager singing styles from the historical early 20th to the contemporary 21st century epochs.

STUDY DESIGN/METHODS

A total of 51 commercial recordings of two songs, "Es muss was Wunderbares sein" by Ralph Benatzky, and "Die ganze Welt ist himmelblau" by Robert Stolz, from "The White Horse Inn" ("Im weißen Rößl") were collected from opera, operetta, and Schlager singers. Each sample was annotated using Praat and analyzed in a custom Matlab- and Python-based algorithmic approach of singing voice separation and sine wave fitting novel to vibrato research.

RESULTS

With respect to vibrato rate and extent, the three most notable findings were that (1) f_o and vibrato were inherently connected; (2) Schlager, as a historical aesthetic category, has unique vibrato characteristics, with higher overall rate and lower overall extent; and (3) f_o and vibrato extent varied over time based on the historical or contemporary recording year for each genre.

CONCLUSIONS

Though these results should be interpreted with caution due to the limited sample size, conducting such acoustical analysis is relevant for voice pedagogy. This study sheds light on the complexity of vocal vibrato production physiology and acoustics while providing insight into various aesthetic choices when performing music of different genres and stylistic time periods. In the age of crossover singing training and commercially available recordings, this investigation reveals important distinctions regarding vocal vibrato across genres and eras that bear beneficial implications for singers and teachers of singing.

Acoustical Theory of Vowel Modification Strategies in Belting

Various authors have argued that belting is to be produced by "speech-like" sounds, with the first and second supraglottic vocal tract resonances (f_R1 and f_R2) at frequencies of the vowels determined by the lyrics to be sung. Acoustically, the hallmark of belting has been identified as a dominant second harmonic, possibly enhanced by first resonance tuning (f_R1≈2f_o). It is not clear how both these concepts - (a) phonating with "speech-like," unmodified vowels; and (b) producing a belting sound with a dominant second harmonic, typically enhanced by f_R1 - can be upheld when singing across a singer's entire musical pitch range. For instance, anecdotal reports from pedagogues suggest that vowels with a low f_R1, such as [i] or [u], might have to be modified considerably (by raising f_R1) in order to phonate at higher pitches. These issues were systematically addressed in silico with respect to treble singing, using a linear source-filter voice production model. The dominant harmonic of the radiated spectrum was assessed in 12987 simulations, covering a parameter space of 37 fundamental frequencies (f_o) across the musical pitch range from C3 to C6; 27 voice source spectral slope settings from -4 to -30 dB/octave; computed for 13 different IPA vowels. The results suggest that, for most unmodified vowels, the stereotypical belting sound characteristics with a dominant second harmonic can only be produced over a pitch range of about a musical fifth, centered at f_o≈0.5f_R1. In the [ɔ] and [ɑ] vowels, that range is extended to an octave, supported by a low second resonance. Data aggregation - considering the relative prevalence of vowels in American English - suggests that, historically, belting with f_R1≈2f_o was derived from speech, and that songs with an extended musical pitch range likely demand considerable vowel modification. We thus argue that - on acoustical grounds - the pedagogical commandment for belting with unmodified, "speech-like" vowels can not always be fulfilled.

Prospective Determination of Normative Value of the Singing Voice Handicap Index-10 (SVHI-10)

OBJECTIVES/HYPOTHESIS

To prospectively establish a normative value for the validated Singing Voice Handicap Index-10 (SVHI-10) patient reported outcome measure (PROM).

STUDY DESIGN

Prospective cross-sectional study.

METHODS

Adult singers without voice complaints were prospectively invited to complete a demographics questionnaire followed by the SVHI-10. Participants were excluded if they had sought medical care for voice changes within the last year or currently had throat problems. Statistical analysis was completed to establish a normative value and the distribution of demographics by singing experience, primary genre, and gender.

RESULTS

One hundred forty-nine healthy participants from diverse backgrounds (including singing, financial, educational, and geographic location) successfully completed the SVHI-10. The mean (SD) score of this cohort was 9.13 (5.15). We defined a normative value as two standard deviations above the mean: 19.43 There was no difference in SVHI-10 score in different age groups.

CONCLUSIONS

A normative value for the SVHI-10 questionnaire has been missing from the current literature and will be of great utility both in clinical practice and research. In previous research, singers have been shown to be more perceptive to quality change in their singing voices, which may be why the normative score is higher than one may expect. A SVHI-10 score ≥20 should be considered abnormal.

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.

Objective Measures of Two Musical Interpretations of an Excerpt From Berlioz's "La mort d'Ophélie"

OBJECTIVE/HYPOTHESIS

This study aimed to determine objective production differences relative to two emotional interpretations in performing an excerpt from a classical art song. The null hypothesis was proposed.

METHODS

The first author recorded an excerpt from an art song. The excerpt was sung with two contrasting musical interpretations: an "empathetic legato" approach, and a "sarcastic" approach characterized by emphatic attacks. Microphone, airflow, and electroglottography signals were digitized. The vowels were analyzed in terms of intensity, long term average spectra, fundamental frequency (f_o), airflow vibrato rate and extent, vowel onset slope, intensity comparison of harmonic frequencies, and glottal measures based on electroglottograph waveforms. Four consonant tokens were analyzed relative to airflow, voice onset time, and production duration.

RESULTS & CONCLUSIONS

The emphatic performance had faster vowel onset, increased glottal adduction, increased intensity of harmonics in 2-3 kHz, increased intensity in the fourth and fifth formants, inferred subglottal pressure increase, increased airflow for /f/, and greater aspiration airflow for /p, t/. Vibrato extents for intensity, f_o, and airflow were wider in the emphatic approach. Findings revealed larger EGGW25 and peak-to-peak amplitude values of the electroglottography waveform, suggesting greater vocal fold contact area and longer glottal closure for the emphatic approach. Long-term average spectrum analyses of the entire production displayed minor variation across all formant frequencies, suggesting an insignificant change in vocal tract shaping between the two approaches. This single-case objective study emphasizes the reality of physiological, aerodynamic, and acoustic production differences in the interpretive and pedagogical aspects of art song performance.

Development of a New Self-Assessment Tool for Laryngopharyngeal Reflux Screening in Singers (SVHI-12-LPR)

INTRODUCTION

The present study aimed to develop a new tool for the evaluation of singers with self-reported symptoms suggestive of laryngopharyngeal reflux (LPR) (the SVHI-12-LPR), by correlating RSI with SVHI in a population sample of 163 subjects (both professional and amateur singers), evaluated also by videolaryngostroboscopy. This study was a cross-sectional, double-observational study.

METHODS

RSI and SVHI were administered to 159 singers (amateurs, singing students, and professional singers). All subjects underwent videolaryngostroboscopy to objectively identify four subgroups: normal subjects (41.5%), subjects with organic lesions occupying the glottic space (17.6%), subjects with functional dysphonia (18.2%), and subjects presenting solely signs suggestive of LPR (22.6%). Using the validated RSI threshold, 33.9% of participants presented an RSI total score >13, suggestive of LPR.

RESULTS

Subjects with a suspected diagnosis of LPR at videolaryngostroboscopy presented a mean RSI significantly higher than other subgroups (p < 0.001). Moreover, the SVHI-36 score did not statistically differ between pathological subgroups. A significant positive relationship was observed between RSI and SVHI total score (Spearman's rank correlation coefficient [ρ] = 0.474, p < 0.001). 12 SVHI items (items 1, 2, 4, 5, 6, 7, 12, 20, 24, 25, 26, 30) showed a significant association with RSI pathology classification. Statistical analysis demonstrated for the 12 selected items (SVHI-12-LPR) acceptable specificity (0.691) and sensibility (0.833) for the suspected diagnosis of LPR with a cut-off of 15.

CONCLUSIONS

From the SVHI-36, 12 items were extracted that correlated with the specific impact that LPR has on the singer's voice (SVHI-12-LPR), as evaluated by RSI and videolaryngostroboscopy. Such questionnaire represents a new tool that could be applied to singers with symptoms suggestive of LPR to select which patients would benefit from a further phoniatric and videolaryngostroboscopic evaluation.

Face Mask Acceptability for Communal Religious Worship During the COVID-19 Pandemic in the United Kingdom: Results from the CONFESS Study

The COVID-19 pandemic has led to restrictions such as social distancing and mandatory wearing of face masks. Singing and religious gatherings have been linked to infection clusters, and between 2020 and 2021 indoor congregational singing and chanting were prohibited in the United Kingdom. We evaluated attitudes to face mask use and their acceptability as well as changes within places of worship since their reopening in July up to autumn 2020. In this cross-sectional study, participants were recruited using convenience sampling through selective targeting of religious organisations and social media. Participants self-enrolled and completed an online questionnaire, which included open and closed questions. We used multivariable logistic regression to identify factors associated with face mask acceptability. We performed thematic analysis to evaluate responses to open questions. A total of 939 participants were included in the analysis. Median age was 52.7 years and 66.1% were female, while 80.7% identified as Christian. A majority (672/861; 78.0%) of participants would find it acceptable to wear a face mask and reduce their singing or chanting volume if required, even though 428/681 (49.1%) found face masks to be uncomfortable. Multivariable regression found that younger age was associated with a higher acceptability of face masks (adjusted OR (aOR): 0.98 (95% confidence interval (95% CI) 0.96-1.00), p = 0.0218). The majority of respondents stated that religious services had become shorter, attended by fewer people and with reduced singing or chanting. Most (869/893, 97.3%) stated their place of worship complied with government guidelines, with 803/887 (90.5%) reported that their place of worship enforced face mask wearing and 793/887 (89.4%) at least moderately happy with precaution measures. Our study demonstrates the significant impact of COVID-19 in places of worship but a high degree of compliance with guidelines. Face masks, despite practical difficulties, appeared to be more acceptable if there was an incentive of being able to sing and chant.

The Key to Singing Off-Key: The Trained Singer and Pitch Perception Distortion

OBJECTIVES

Pitch perception distortion (PPD) is a novel term describing a phenomenon in which an amplified, accompanied singer's perception of their sung pitch relative to band or accompaniment becomes ambiguous, leading to one of two conditions: a) the singer believes they are out of tune with the accompaniment, but are in tune as perceived by a listener, or b) the singer believes they are in tune with the accompaniment, but are not. This pilot study aims to investigate the existence and incidence of PPD among amplified, accompanied performers and identify associated variables.

DESIGN/METHODS

115 singers were recruited to participate in an online survey, which collected information on musical training, performance environment, and PPD experience.

RESULTS

Reported PPD incidence was 68%, with 92% of respondents indicating that PPD occurred rarely. The factors reported as most associated with PPD experiences included loud stage volume, poor song familiarity, singing outside one's habitual pitch range, and singing loudly. Contrary to previous studies and our hypotheses, no association was found between modality of auditory feedback (e.g., in-ears versus floor monitors) and incidence of PPD. Additionally, higher levels of training were found to be associated with higher incidence of PPD.

CONCLUSIONS

The reported incidence supports that PPD exists beyond chance and anecdotal experience. In light of the highly trained sample, the data suggest that pitch accuracy in accompanied, amplified performance may be more associated with aural environment-specifically loud stage volume-and a highly trained singer's tuning strategy in response to that environment rather than a singer's mastery of vocal intonation skills in isolation. Loud stage volume was implicated as a primary factor associated with PPD, which may be related to the stapedius reflex. Future investigations will target attempted elicitation of PPD in trained singers after establishing baseline auditory reflex thresholds and objective measurements of intonation accuracy.

Community Choir Improves Vocal Production Measures in Individuals Living with Parkinson's Disease

OBJECTIVES

Parkinson's disease (PD) is a neurodegenerative disease leading to motor impairments and dystonia across diverse muscle groups including vocal muscles. The vocal production challenges associated with PD have received considerably less research attention than the primary gross motor symptoms of the disease despite having a substantial effect on quality of life. Increasingly, people living with PD are discovering group singing as an asset-based approach to community building that is purported to strengthen vocal muscles and improve vocal quality.

STUDY DESIGN/METHODS

The present study investigated the impact of community choir on vocal production in people living with PD across two sites. Prior to and immediately following a 12-week community choir at each site, vocal testing included a range of vocal-acoustic measures, including lowest and highest achievable pitch, duration of phonation, loudness, jitter, and shimmer.

RESULTS

Results showed that group singing significantly improved some, though not all, measures of vocal production. Group singing improved lowest pitch (both groups), duration (both groups), intensity (one group), and jitter (one group) and shimmer (both groups).

CONCLUSIONS

These findings support community choir as a feasible and scalable complementary approach to managing vocal production challenges associated with PD.

Auditory cognitive aging in amateur singers and non-singers

The notion that lifestyle factors, such as music-making activities, can affect cognitive functioning and reduce cognitive decline in aging is often referred to as the mental exercise hypothesis. One ubiquitous musical activity is choir singing. Like other musical activities, singing is hypothesized to impact cognitive and especially executive functions. Despite the commonness of choir singing, little is known about the extent to which singing can affect cognition in adulthood. In this cross-sectional group study, we examined the relationship between age and four auditory executive functions to test hypotheses about the relationship between the level of mental activity and cognitive functioning. We also examined pitch discrimination capabilities. A non-probabilistic sample of 147 cognitively healthy adults was recruited, which included 75 non-singers (mean age 52.5 ± 20.3; 20-98 years) and 72 singers (mean age 55.5 ± 19.2; 21-87 years). Tests of selective attention, processing speed, inhibitory control, and working memory were administered to all participants. Our main hypothesis was that executive functions and age would be negatively correlated, and that this relationship would be stronger in non-singers than singers, consistent with the differential preservation hypothesis. The alternative hypothesis - preserved differentiation - predicts that the difference between singers and non-singers in executive functions is unaffected by age. Our results reveal a detrimental effect of age on processing speed, selective attention, inhibitory control and working memory. The effect of singing was comparatively more limited, being positively associated only with frequency discrimination, processing speed, and, to some extent, inhibitory control. Evidence of differential preservation was limited to processing speed. We also found a circumscribed positive impact of age of onset and a negative impact of singing experience on cognitive functioning in singers. Together, these findings were interpreted as reflecting an age-related decline in executive function in cognitively healthy adults, with specific and limited positive impacts of singing, consistent with the preserved differentiation hypothesis, but not with the differential preservation hypothesis.

The Skagit County choir COVID-19 outbreak - have we got it wrong?

OBJECTIVES

Over time, papers or reports may come to be taken for granted as evidence for some phenomenon. Researchers cite them without critically re-examining findings in the light of subsequent work. This can give rise to misleading or erroneous results and conclusions. We explore whether this has occurred in the widely reported outbreak of SARS-CoV-2 at a rehearsal of the Skagit Valley Chorale in March 2020, where it was assumed, and subsequently asserted uncritically, that the outbreak was due to a single infected person.

STUDY DESIGN

Review of original report and subsequent modelling and interpretations.

METHODS

We reviewed and analysed original outbreak data in relation to published data on incubation period, subsequent modelling drawing on the data, and interpretations of transmission characteristics of this incident.

RESULTS

We show it is vanishingly unlikely that this was a single point source outbreak as has been widely claimed and on which modelling has been based.

CONCLUSION

An unexamined assumption has led to erroneous policy conclusions about the risks of singing, and indoor spaces more generally, and the benefits of increased levels of ventilation. Although never publicly identified, one individual bears the moral burden of knowing what health outcomes have been attributed to their actions. We call for these claims to be re-examined and for greater ethical responsibility in the assumption of a point source in outbreak investigations.

The Role of Vibrato in Group Singing: A Systematic Review

INTRODUCTION

Arguably one of the most controversial features of the singing voice, especially in a choral context, is the phenomenon of vibrato. Numerous pedagogical articles, mostly written by experienced choral singers or directors, discuss the importance of vibrato, sharing anecdotal insights about its control (often advocating reduction) in choral blend and vocal health.

OBJECTIVES

This systematic review aims to identify the main questions posed in the empirical study of vibrato during group singing, and how they have been addressed to date through empirical investigations.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was employed for this review. The review team consisted of the two authors. A data extraction form was designed to capture information about the participants (including age, gender, music and singing experience), study methods, experimental procedures, outcome measures, and statistical findings.

RESULTS

Seventeen studies were included in the review and revealed that (a) relatively few empirical investigations have studied vibrato in vocal ensembles; (b) the majority focused on vibrato production rather than perception; (c) methodological approaches include Synthesis, Multi-track recordings, Stereo/Binaural recordings, and Lx/Contact recordings; and (d) the studies focused on the main themes of Adjustment, Identification, Interaction, Intonation, and Style.

CONCLUSION

With the current body of literature, it is not possible to draw general conclusions around vibrato behavior during group singing. However, the review highlights the main subareas of interest and valuable methods which have been established and through which future research can collectively shed further light on the role of vibrato in choral singing.

SINFONIA study protocol: a phase II/III randomised controlled trial examining benefits of guided online group singing in people with chronic obstructive pulmonary disease and interstitial lung disease and their carers

Background

Chronic obstructive pulmonary disease (COPD) and interstital lung disease (ILD) are incurable conditions characterised by airflow limitation, persisting respiratory symptoms, and progressive respiratory failure. People living with COPD or ILD often suffer from chronic and severe breathlessness, with limited treatment options and low engagement rates with current therapies. Group singing represents a potential community-based therapy to improve quality of life for patients with COPD or ILD and breathlessness.

Methods

This protocol papers describes SINFONIA, a parallel, double-arm, randomised, blinded-analysis, mixed-methods phase II/III trial of guided, online group singing that will be conducted over 24 months. Adults with confirmed COPD or ILD, on stable treatment for at least four weeks at time of recruitment, with a modified Medical Research Council (mMRC) dyspnoea score of two or greater, who are capable and willing to give consent, and not currently participating in pulmonary rehabilitation will be eligible to participate. Carers may optionally enrol in the trial. Data will be collected on quality of life, anxiety and depression, breathlessness, mastery of breathing, exercise tolerance, loneliness, healthcare utilisation, and carer quality of life (optional). Participants will be randomised 1:1 to intervention or control arms with intervention arm attending one 90 min, guided, online, group singing session per week for 12 weeks and control arm continuing routine care. Phase II of the trial aims to determine the feasibility and acceptability of guided, online group singing and will collect preliminary data on effectiveness. Phase III aims to determine whether guided, online group singing has an effect on quality of life with the primary outcome being a between arm difference in quality of life (36-item Short Form Survey) measured at 12 weeks.

Discussion

SINFONIA is the first study is the first of its kind in Australia and to our knowledge, the first to deliver the singing intervention program entirely online. Determining the feasibility, acceptability, and effectiveness of guided, online group singing is an important step towards improving low-cost, low-risk, community-based therapeutic options for patients living with COPD or ILD and breathlessness.

Trial registration: Phase II—ACTRN12621001274864, registered 20th September 2021; Phase III—ACTRN12621001280897, registered 22nd September 2021.

Relationship Between Oropharyngeal Geometry and Acoustic Parameters in Singers: A Preliminary Study

OBJECTIVE

To verify possible correlations between formant and cepstral parameters and oropharyngeal geometry in singers, stratified by sex.

METHOD

Voice records and oropharyngeal measures of 31 singers - 13 females and 18 males, mean age of 28 (±5.0) years - were retrieved from a database and analyzed. The oropharyngeal geometry measures were collected with acoustic pharyngometry, and the voice records consisted of sustained vowel /Ԑ/ phonation, which were exported to Praat software and edited to obtain the formant and cepstral parameters, stratified by sex. The Pearson linear correlation test was applied to relate voice parameters to oropharyngeal geometry, at the 5% significance level; the linear regression test was used to justify the variable related to the second formant.

RESULTS

Differences between the sexes were identified only in the oral cavity length (greater in males) and pharyngeal cavity length (greater in females). There was a linear correlation between the third formant and the cepstrum in the female group. In the male group, there was a linear correlation between the cepstrum and the third and fourth formants. A positive linear correlation with up to 95% confidence was also identified between the pharyngeal cavity volume and the second formant in the female group, making it possible to estimate a regression model for the second formant (R2 = 0.70).

CONCLUSION

There are correlations between the oropharyngeal geometry and formant and cepstral parameters in relation to sex. The pharyngeal cavity volume showed the greatest correlation between females and the second formant.

Developmental History of the Vocal Tract Organ

OBJECTIVES

The Vocal Tract Organ has had a number of iterations resulting from advances in available technology as well as requirements of perceptual experiments and performance paradigms. The objective of this paper is to relate the development history of the Vocal Tract Organ from the original vision to what it is today as a modern version of the Vox Humana pipe organ stop for application in voice production and perception research.

STUDY DESIGN

Descriptive METHODS/DESIGN: The latest Vocal Tract Organ is a polyphonic eight-channel eight-stop one manual Vocal Tract Organ that enables tab stop selected three-D printed vocal tracts to be used to create sound. This version includes eight stops (four for female vowel oral tracts and four for male vowel oral tracts). The stops are implemented using conventionally engraved pipe organ stop tabs labeled "Vox Humana Female" or "Vox Humana Male" followed by the three-D printed vowel: "EE", "AH", "ER" or "UU." This is described alongside the development stages from which it emerged and covers all previous versions of the Vocal Tract Organ. At the heart of the latest instrument is a Bela BeagleBone Black with a Bela cape audio expander board which incorporates eight 16-bit audio outputs at 44.1 kHz sampling rate (earlier versions based on the Arduino Mega board were limited to 8-bit audio at an audio sampling rate of 16.384 kHz which limited the overall output spectrum). The latest Vocal Tract Organ is programmed using the audio graphical programming language Pure Data which is directly compatible with the Bela system. The Pure Data patch creates eight larynx outputs at the pitches set by the keys depressed on the keyboard and these are routed to Vocal Tract Organ loudspeakers with three-D printed vocal tracts attached.

RESULTS

The Bela system has enabled real-time synthesis of eight-note polyphonic sounds to eight separate three-D printed vocal tracts, each being selectable via an organ tab stop switch. The instrument has been cased in a purpose-designed and built prototype laser-cut enclosure that incorporates the eight tab stops, a MIDI keyboard input, a pipe organ style swell (volume) pedal connection, four stereo (eight channels) audio amplifiers and terminal connections for the eight loudspeakers.

CONCLUSIONS

The Vocal Tract Organ functions as a musical instrument for performance and as an instrument for vowel and pitch perception research. Implementing it with the Bela family of processors allows for low audio latency of 1 ms and rapid prototyping due to being able to program directly with the high-level graphical audio programming language, Pure data (Pd).

The Effect of Different Preparatory Conducting Gestures on Breathing Behavior and Voice Quality of Choral Singers

OBJECTIVE

The breathing technique is a determining factor for the singer's sound quality and consequently crucial for the choral sound. However, very little is known about possible influences of the conductor's preparatory gesture on the way choral singers inhale before the beginning of a piece (respectively every subsequent phrase). The conducting literature does not discriminate between out- and inward preparatory gestures and even describes them as equivalent, but previous studies suggest that singers assign different types of inhalation to different preparatory gestures. It may therefore be assumed that the type of preparatory gesture has a direct influence on the singer's inhalation and tone production, and the aim of this study is hence to examine possible effects of two contrasting preparatory gestures on the singer's inhalation type and the resulting tone quality.

METHODS

In our within-subjects study design, 18 healthy choral singers (9 male/ 9 female) were recruited to participate in a laboratory experiment. The participants were asked to sing a tone suitable for their voice register in response to different video stimuli. These consisted of two conducting-videos, each showing a different preparatory gesture, and two control conditions with an animated bar and an arrow indicating the desired breathing type. The singers reacted to 10 sets of videos, each set consisting of the four stimuli in randomized order. For evaluation of the breathing behavior and vocal output during the different experimental conditions, chest wall kinematics of upper rib cage, abdominal rib cage and abdomen were measured via 3D motion capture and voice samples were recorded. The obtained data were filtered and compared using the repeated measures analysis of variance and post hoc Tukey test for significant results. The level of significance was set at P < 0.05.

RESULTS

The results of the study show significant differences in volume of the abdomen between the two different gestures (F1,17 = 24.04, η2 = 0.59, P = 0.0001), which can be validated by the two control measurements (F1,17 = 21.12, η2 = 0.55, P = 0.0002). An outward preparatory gesture evoked an abdominal breathing type while an inward-upward movement led to an inhalation with a higher portion of clavicular breathing. Furthermore, significant differences in timbre and loudness of the produced tone could be observed. The maximum sound pressure level of the outward preparatory gesture was significantly higher than in case of the inward-upward movement (F1,17 = 20.4, η2 = 0.56, P = 0.0004).

CONCLUSIONS

In contrast to the existing conducting literature, which does not discriminate between out- and inward preparatory gestures, the results of this study show that the conductor's choice of trajectory direction and form of the preparatory gestures elicit spontaneous, gesture-specific reactions in singers' breathing behavior as well as the corresponding loudness and sound quality.

Online singing interventions for postnatal depression in times of social isolation: a feasibility study protocol for the SHAPER-PNDO single-arm trial

BACKGROUND

Postnatal depression (PND) affects 13% of new mothers, with numbers rising during the COVID-19 pandemic. Despite this prevalence, many women have difficulty with or hesitancy towards accessing pharmacological and/or psychological interventions. Group-based mother-baby activities, however, have a good uptake, with singing improving maternal mental health and the mother-infant relationship. The recent lockdowns highlight the importance of adapting activities to an online platform that is wide-reaching and accessible.

AIMS

The SHAPER-PNDO study will primarily analyse the feasibility of a 6-week online singing intervention, Melodies for Mums (M4M), for mothers with PND who are experiencing barriers to treatment. The secondary aim of the SHAPER-PNDO study will be to analyse the clinical efficacy of the 6-week M4M intervention for symptoms of postnatal depression.

METHODS

A total of 120 mothers and their babies will be recruited for this single-arm study. All dyads will attend 6 weekly online singing sessions, facilitated by Breathe Arts Health Research. Assessments will be conducted on Zoom at baseline and week 6, with follow-ups at weeks 16 and 32, and will contain interviews for demographics, mental health, and social circumstances, and biological samples will be taken for stress markers. Qualitative interviews will be undertaken to understand the experiences of women attending the sessions and the facilitators delivering them. Finally, data will be collected on recruitment, study uptake and attendance of the programme, participant retention, and acceptability of the intervention.

DISCUSSION

The SHAPER-PNDO study will focus on the feasibility, alongside the clinical efficacy, of an online delivery of M4M, available to all mothers with PND. We hope to provide a more accessible, effective treatment option for mothers with PND that can be available both during and outside of the pandemic for mothers who would otherwise struggle to attend in-person sessions, as well as to prepare for a subsequent hybrid RCT.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04857593 . Registered retrospectively on 22 April 2021. The first participants were recruited on 27 January 2021, and the trial is ongoing.

Effects of Choir Singing on Mental Health: Results of an Online Cross-sectional Study

OBJECTIVES

The study aims to quantify the impact of sociodemographic, personal, and choir-related characteristics on perceived singing well-being and mental health changes due to singing.

STUDY DESIGN

847 German adult choristers (233m, 614f, age 18-86 years) were interviewed in a cross-sectional online questionnaire study that included questions on singing well-being, vocal and choral characteristics, the adapted versions of the Bochum change questionnaire (BCQ2000), the Utrecht Work Engagement Scale (UWES-09), and the WHO-5 well-being index.

METHODS

Multiple regression models were calculated with singing related well-being or mental health changes as dependent variables and individual and choir-related characteristics as factors. Predictors of mental health benefits were analyzed in gender subgroups and in persons with a low or normal/high score on the WHO-5.

RESULTS

On average, participants rated the impact of singing on well-being and mental health changes positively. Subgroup analysis revealed smaller but significant positive mental health effects in men compared to women and in persons with a low WHO-5 score compared to those with a normal/high score. Education level and relationship status were not significantly related to subjects' perceptions of mental health benefits, whereas singing well-being increased with age in women and in participants with a low WHO-5 score. Larger improvements in mental health came along with longer choir membership, more singing hours per week, and a high engagement in choral activity. Significant positive associations of well-being with optimal singing behavior and vocal warm-ups were observed.

CONCLUSION

Results suggest that singers of all ages, genders, and educational backgrounds perceive the choral experience as beneficial to their well-being and mental health. Positive effects are related to WHO-5 scores, engagement in choral activity, and optimal singing conditions. On average, women rate singing benefits higher than men and singers with preexisting vocal pathologies or low WHO-5 benefit slightly less.

Effects of the Voiced Tongue Trill Technique in Glissandos on the Voice Range Profile of Choir Members: A Preliminary Study

The objective of this study was to verify the immediate effect of the voiced tongue trill technique in ascending and descending glissandos on the voice range profile of choir members. A total of 25 sopranos, mezzo-sopranos, contraltos, tenors, and baritones participated in the study. They were choir members, aged 20 to 45 years, with no voice symptoms, and able to perform the voiced tongue trill technique. Their voice range profile was analyzed before and after performing the ascending and descending technique for 2 and 5 minutes. The maximum fundamental frequency values in the study groups increased after performing the ascending and descending technique for 2 minutes (P = 0.001) and 5 minutes (P = 0.003). The range in Hz increased after 2 minutes (P = 0.010) and 5 minutes (P = 0.050) of the ascending technique and after 2 minutes (P = 0.001) of the descending technique, and the minimum fundamental frequency mean value suffered interference from the type of technique (ascending/descending). The immediate effects of VTTT in glissandos on the VRP of choir members' considering the two factors: condition and time, in ascending and descending glissandos for 2 and 5 minutes increased the maximum frequency and the range in Hz of choristers. Regarding volume levels results, no difference was found in intensity after applying the technique.

Pregnancy and the Singing Voice: A Survey of What Singers Report

Pregnancy has profound effects on a variety of body systems by way of hormonal and physical changes. Many of these changes directly affect body systems involved in singing. Assumptions exist about what can happen to a person's voice during pregnancy, but these assumptions are based on theoretical predictions leaving little knowledge of the lived experiences of voice changes during pregnancy. An anonymous mixed-method survey was given to 321 professional singers to gain insights on the lived experiences of pregnant singers. This investigation explored what people were told about the effects of pregnancy on the voice in comparison to what they actually experienced. Results show that about half of the respondents' experience matched what they were told for respiration. For phonation and vocal quality less than 25% respondent's experience matched what they were told. In addition, most of the information respondents received came from friends, colleagues, and teachers compared to medical professionals suggesting a need for more interdisciplinary education to best prepare vocalists who are contemplating becoming pregnant.

Creative dance associated with traditional Portuguese singing as a strategy for active aging: a comparative cross-sectional study

BACKGROUND

Multimodal forms of exercise can influence several physical and mental factors important for successful aging. In the present study, we introduce a new type of multimodal intervention, combining movement (creative dance) with traditional singing. This study aims to compare physical fitness, functional physical independence, depressive symptoms, general cognitive status, and daytime sleepiness among older adults participating in multimodal exercise, those participating in traditional physical exercise, and those not actively engaged in physical exercise.

METHODS

This cross-sectional study included 112 people aged ≥ 65 years (75.3 ± 0.7 years) living independently in the community, divided into 3 groups: multimodal exercise (n = 34), traditional exercise (n = 41), and no physical exercise (n = 37).

RESULTS

The multimodal exercise group showed greater flexibility of the lower limbs and upper limbs/shoulders and better general cognitive status than the traditional exercise group (p < 0.05). The traditional exercise group had better agility and dynamic balance, aerobic endurance, and strength of the lower and upper limbs than the no-exercise group (p < 0.05).

CONCLUSIONS

The results suggest that the two types of programs studied may have different impacts on some of the variables investigated and support the design of future experimental studies that include interventions based on the combination of creative dance and traditional Portuguese singing.