Factors Associated With Singers' Perceptions of Choral Singing Well-Being

How older adults relate to their own voices: a qualitative study of subjective experiences of the aging voice

AIM

The aim of this study was to investigate how otherwise healthy older adults with self-assessed voice problems relate to their voice and voice changes.

METHOD

Focus groups were conducted at an activity center to identify how older adults reflect on their own voice and the aging voice in general. The interviews were audio recorded and transcribed. The analysis was done using thematic content analysis.

RESULTS

The analysis resulted in three main themes: "communicational aspects of the aging voice," "consequences of deteriorating vocal and communicative capacity," and "attitudes, strategies, and ideas". The participants considered voice to be an important communication tool and presented what could be interpreted as awareness regarding their voice. Voice changes were considered a natural part of aging. This attitude was also an important reason why the participants had not sought medical care for their voice problems. The participants discussed ideas concerning extended voice use to maintain a functioning voice when aging. Simultaneously, voice changes due to aging were considered to have a negative effect on communication and social participation.

CONCLUSIONS

The voice is important for older adults, and an insufficient voice can affect communication and social participation. Information about aging voice and voice exercises, for example from speech language pathologists, could be of interest among older adults. Further studies on the voice of older adults are needed regarding how they experience their voice and the general aspects of a healthy aging voice.

Amateur choir singers - Does good vocal health matter?

BACKGROUND

Many amateur singers enjoy singing in choirs. They are likely to lack the training and expertise of professional singers and this may have an impact on their vocal health.

AIMS

To assess the experiences of amateur singers, their use of warm-up and cool-down sessions, their vocal health, their sources of help and advice and their reactions to receiving a diagnosis and treatment.

METHODS AND PROCEDURES

A questionnaire was sent to amateur choir singers. Quantitative data on their use of warm-up and cool-down activities were collected and the singers rated how frequently they experienced adverse voice symptoms after singing. Qualitative data were collected from singers who had sought advice about their voice and from those who had received a diagnosis and treatment.

OUTCOME AND RESULTS

Most choirs used warm-up sessions but few used cool-down. Singers who participated in choir warm-ups experienced significantly less vocal symptoms. Individual warm-ups were ineffective. Singers who had previously had a diagnosis continued to have significantly higher symptom scores. A quarter of the singers who had neither sought help nor had a diagnosis had high scores. Singers appeared uncertain about who to consult for help. Those who saw a speech and language therapist were much more likely to receive a diagnosis and treatment either by the therapist or by referral to an ear, nose and throat specialist. Those receiving treatment were mainly positive about it and likely to complete a course of therapy.

CONCLUSIONS AND IMPLICATIONS

Warm-up sessions performed by choirs are helpful in avoiding voice symptoms and are recommended. The presence of singers who are unaware of potential damage to their voices is a concern. A simple rating system, as used in this research, may act to alert them to the dangers. Choir leaders could be more active in advising singers and refer them to professionals where necessary. Speech and language therapists appear more sensitive to their problems and could be a first point of contact.

WHAT THIS PAPER ADDS

What is already known on this subject Poor vocal health may occur in amateur singers and lead to voice disorders which will reduce the demonstrated benefits of regular singing. They may be less aware than professional singers of potential hazards and may not know how to sing in a way that ensures good vocal health. There has been less research on the extent of voice problems in amateurs or of the actions they may take to resolve the vocal difficulties they encounter. What this paper adds to the existing knowledge This survey demonstrates that choir warm-ups were effective in helping to avoid common symptoms associated with voice problems. A large minority of singers who had not sought help for voice problems had high symptom scores on our assessment. Singers frequently turned to a singing teacher for help. Those who consulted a speech and language therapist were much more likely to be referred for further investigation and treatment. What are the potential or actual clinical implications of this work? We present a simple subjective measure of symptom severity which succeeds in distinguishing between singers who warm up their voices and those who do not and between singers who have received a past diagnosis and those who have not. There are a number of indications in this research that amateur singers are unsure if they need help and are uncertain who can offer it. In these circumstances the use of a simple measure of the severity of vocal abuse may be useful.

Interpersonal synchrony when singing in a choir

Singing in a choir has long been known to enhance well-being and protect mental health. Clearly, the experience of a uniquely harmonious social activity is very satisfying for the singers. How might this come about? One of the important factors positively associated with well-being is interpersonal action coordination allowing the choir to function as a whole. This review focuses on temporal coordination dynamics of physiological systems and/or subsystems forming part or the core of the functional substrate of choir singing. These coordination dynamics will be evaluated with respect to the concept of a superordinate system, or superorganism, based on the principles of self-organization and circular causality. We conclude that choral singing is a dynamic process requiring tight interpersonal action coordination that is characterized by coupled physiological systems and specific network topology dynamics, representing a potent biomarker for social interaction.

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.

Effects of teaching experience and culture on choral directors' descriptions of choral tone

In this study we examine the effects of experience and culture on choral teachers’ description of choral tone across a range of genres. What does a “good” choral music performance sound like? Is there an objective standard of performance excellence, or is beauty in the eye of the beholder? In teacher preparation programs, choral directors in the United States have been taught to identify and teach particular, culturally-bounded standards of choral tone in their students. Choral directors evaluate their students’ voices along two dimensions: health and appropriateness. They discern and describe whether the student’s musical instrument—their voice—is producing sound in a healthy and non-damaging way. They also judge whether the style of their sound is appropriate for the music they are singing. However, teacher preparation programs do not provide common standards or lexicon for describing tone. This may increase implicit bias of individual directors, and inadvertently exacerbate ethnocentrism and harm students’ self-perception. Using a computational text analysis approach, we evaluate the content of open-ended survey responses from teachers, finding that the language used to describe and rate choral performance varies by experience, and by the choral selection (e.g., whether it is a traditional Western or non-Western song). We suggest that regularizing the terminology and providing common training through professional organizations can minimize potential bias and generate more systematic, precise use of qualitative descriptors of health and appropriateness, which will benefit students and teachers.

Clinical characteristics of singers attending a phoniatric outpatient clinic

Purpose: Studies suggest that singers are over-represented in voice clinics and present a high risk of developing voice disorders. This retrospective study aims to describe the characteristics of 78 singers consulting a phoniatrician.Methods: In their medical files, data related to age, gender, occupational status, singing training, musical style, voice complaint, diagnosis, voice-quality grading (GRBAS) and treatment were gathered.Results: The patients were mostly female singers (87%). Non-professional singers (semi-professional included) represented 64%, professional singers 25% and students of singing 11%. The majority of singers were choristers (27%) and 22% were classical-style/oratorio-style singers. Two-thirds of the population had intensive vocal activity in speech or singing. Vocal endurance, somatosensory signs and difficulties with high pitches were the most frequent symptoms. Among the patients, 79% presented with singing-voice disorders with 85% of these having vocal fold lesions. Generally, their speaking voices were preserved. Vocal-folds nodules were the most prevalent pathology (37%) followed by sulcus (26%) and voice therapy was the main treatment.Conclusions: This study emphasizes the fact that singers have specific voice complaints related to their voice usage. The high occurrence of sulcus and other congenital-lesion suspicions, unusual in the general population consulting an ENT phoniatrician, seems to be rather specific for singers in agreement with the literature.

A survey of vocal health in church choir singers

Purpose

Choir singing is an important tradition of Christian worship across India. However, vocal health issues related to the church choir singers are less addressed in the literature. Hence, this study aimed to investigate the prevalence of vocal symptoms, identify the variables associated with increased risk of voice problems and knowledge of factors influencing vocal health in church choir singers.

Method

One hundred and forty-eight church choir singers (61 males and 85 females) between the age range of 18 and 70 years participated in the study. They completed a self-reported questionnaire addressing demographic and singing-related details, vocal symptoms, variables associated with increased risk reporting voice problems and knowledge about factors influencing vocal health.

Result

Eighty-four percent of the choir singers reported two or more vocal symptoms sometimes or more frequently while or after singing. More than half of the church choir singers had experienced vocal symptoms such as accessing notes in the upper range, loss of vocal endurance, pitch breaks, hoarseness, dryness in the throat, and discomfort in the throat. Among the different variables, systemic hydration found to have a significant association with reporting of voice problems in church choir singers. The overall knowledge regarding the factors influencing vocal health was found to be limited among the choir singers.

Conclusion

Choir singers like other professional singers experienced a higher prevalence of vocal symptoms during or after singing and exhibited limited knowledge about factors that negatively influence vocal health. Hence, there is a need to look into these singer’s vocal requirements, who usually go unnoticed.

Prevalence, Characterization, and Impact of Voice Disorders in Fado Singers

INTRODUCTION

Fado is a genre of urban folk music from Portugal characterized by some particularities. Some indictions in the study point this population of singers to be at higher risk of developing voice disorders.

AIM

This study aims to provide estimates of the prevalence of voice disorders in Fado singers, and to characterize the professional practice and the impact of voice disorders on their careers.

METHODS

This is a cross sectional study based on a self-administered questionnaire split into six parts and 55 questions.

RESULTS

A gender-balanced sample of 111 singers was achieved. Most of them recorded at least once. Winter and spring were found to be the most difficult seasons in which to sing. The overall prevalence of self-reported voice disorders was 39.6%, significantly higher in females. Almost all sought clinical guidance. Vocal fold nodules, functional dysphonia, and vocal fold polyp were the most common diagnoses. Vocal fatigue and hoarseness were the main symptoms reported. Nearly half of the singers had to cancel shows due to voice disorders.

CONCLUSION

Fado singers reveal both a relative high prevalence of voice disorders and related concerns, even though some discrepancies were found regarding other apparently similar singer populations. These results lead support the need for further investigation regarding the risk or protective factors influencing voice disorders.

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)

Objective

This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia.

Purpose

The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology–head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology.

Action Statements

The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids for patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia.

Disclaimer

This clinical practice guideline is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and it may not provide the only appropriate approach to diagnosing and managing this problem. Differences from Prior Guideline (1) Incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia

Exploring the perceived health benefits of singing in a choir: an international cross-sectional mixed-methods study

Aim:

This mixed-methods exploratory study investigates the perceived health benefits of singing in a choir from an international sample of choristers.

Method:

An online questionnaire including demographic information, 28 quantitative statements and two qualitative questions relating to the perceived health benefits of singing in a choir was distributed via email and social media over a period of 4 months to a sample of 1,779 choristers. Basic descriptives and comparisons between subgroups of the sample are presented along with thematic analysis of qualitative comments.

Results:

Basic descriptives suggest an overwhelmingly positive response. Females scored significantly higher than males on physical benefits, social benefits and emotional benefits. Professional singers reported significantly more physical, social and spiritual benefits than amateur singers. Bias may be present in these findings as the results were entirely self-reported by people who already sing in choirs. Qualitative thematic analysis identified six key themes which may counter this bias by providing deeper understanding of the perceived benefits for choir singers. These include social connection, physical and physiological benefits (specifically respiratory health), cognitive stimulation, mental health, enjoyment and transcendence.

Conclusion:

Choral singing elicits a positive response in the chorister across a plethora of domains. This research confirms previous findings on the health benefits of singing but offers evidence from the largest sample of singers to date. However, results are based on self-perceptions of choristers, and findings are, therefore, limited. Results may be used as a base on which to develop further research in this area. It also provides confirmatory evidence to support choral singing as a means of improving wellbeing in many populations, including but not limited to workplaces, schools, nursing homes, communities and churches.