Vocal Health Education and Medical Resources for Graduate-Level Vocal Performance Students

Barriers to Voice Therapy: A Report From Beginners, Performers, and Teachers of Carnatic Music

AIM

The study aimed to understand awareness, perceptions, and barriers to voice therapy among beginners, performers, and teachers of Carnatic music.

METHOD

Barriers from the literature were obtained, and the guide for the semistructured interview was developed. Twelve Carnatic singers (four each identified as beginners, performers, and teachers) were contacted and interviewed on an online platform. The interviews were audio recorded and transcribed verbatim. The transcriptions were loaded and coded in the Qualitative Data Analysis Miner Lite software. The codes were grouped according to beginners, performers, and teachers. The codes were analyzed using a deductive-inductive approach, and thematic analysis was performed to report the findings.

RESULTS AND DISCUSSION

Overall, three themes emerged during thematic analysis. Beginners were familiar with the signs and symptoms of voice problems related to singing. The performers and teachers were able to identify causes related to posture and lifestyle that impacted singing. The need for seeking help differed with expertise and personal experience. Beginners believed in home remedies as their first choice and considered them sufficient to resolve voice problems. Performers and teachers believed in modifying singing techniques as a remedy to voice problems and considered medical intervention only as a second option. Mixed perceptions about the outcomes of voice therapy and the anticipation of quick results from voice therapy/therapists were major deterrents to seeking professional voice care. Beginners' views on perceptions of medical intervention for voice problems were strongly influenced by their singing teachers. Beginners also expressed limited access to voice therapy due to several logistical reasons and financial constraints as barriers to attending therapy. Performers and teachers sought medical help as a final resort since the presence of voice problems affected their livelihoods and careers.

CONCLUSION

This qualitative study highlights socioculturally relevant information deeply rooted in the belief systems of Carnatic musicians. These opinions from beginners, performers, and teachers are important to be addressed during counseling and awareness sessions to support vocal health in this sophisticated but vulnerable professional voice group.

Prevalence of Complementary and Alternative Medicine Use in Professional Voice Users

Objectives To determine the prevalence and specific modalities of complementary and alternative medicine (CAM) by professional voice users (PVUs) for vocal ailments and to examine the PVU's health care utilization. Methods A Canadian national cross-sectional survey was conducted. Surveys were distributed electronically to members of the Alliance of Canadian Cinema, Television, and Radio Artists; the National Association of Teachers of Singing; the Canadian Actors Equity Association; and the Department of Vocal Performance at Western University. Participants were asked about the products/therapies they use to improve vocal health. Frequency of use, health care utilization, and general influencers in treatment choice were also collected. Results Two hundred eighty-eight participants completed the survey. 86% of participants claimed to have taken at least one form of CAM when experiencing voice loss or a negative voice change. Of the respondents, 18% claimed to use products/therapies for vocal health routinely in the absence of vocal ailments. The most common CAMs used were hot drinks with honey and/or lemon, lozenges, and inhaling steam. When vocally ill, PVUs were significantly more likely to use CAMs than any other treatment method. Voice teachers and medical doctors most commonly influenced the choice of the treatment. Conclusion This study illustrated the substantial prevalence of CAMs in the PVU community. Understanding the utilization of CAMs can help clinicians navigate treatment strategies for this patient population.

Seeing Voices: A Dynamic, Interprofessional Approach to Teaching Performing Arts and Speech-Language Pathology Students About Vocal Anatomy and Physiology

OBJECTIVES

Seeing Voices was an interprofessional, technology-enabled, large-scale, teaching and learning event developed to address the need to improve voice students' knowledge of laryngeal anatomy and physiology toward understanding and maintaining vocal health. Seeing Voices trialed a novel interprofessional educational approach, collected both quantitative and qualitative data about student experiences of laryngostroboscopic examination, and built a databank of laryngeal recordings for future student learning.

METHODS

Seeing Voices involved two 3-hour seminars in a large, university lecture space, run by an interprofessional team (speech-language pathologists, vocal coach, Ear Nose and Throat consultant) with quality equipment projecting laryngeal images to large screens with expert commentary in real time. Participants were 18 students who volunteered for laryngeal examination (9 per seminar) and student attendees (n = 175) from performing arts courses (classical singing, contemporary, jazz, musical theater, acting) and a speech-language pathology course. A quantitative evaluation of knowledge gained was undertaken using a Qualtrics survey. Results from pre (n = 175; performing arts = 120; speech-language pathology (SLP) = 55) and postevent (n = 99; performing arts = 56; SLP = 43) questionnaires were received from the students who attended. Interviews were collected from 15 of the 18 student volunteers about their experiences of nasendoscopic evaluation and data were analyzed using qualitative description and qualitative content analysis.

RESULTS

Quantitative results demonstrated a strong trend toward increased knowledge following attendance at the event across year cohorts for both student groups. Qualitative interviews highlighted the value in seeing multiple examples of normal laryngeal functioning across different vocal techniques in real time. For those undertaking nasendoscopic examination, simultaneously seeing and feeling laryngeal maneuvers used in training appeared to promote understanding of their own vocal mechanism and the purpose of different vocal techniques.

CONCLUSIONS

Seeing Voices offers a novel way to improve interprofessional collaboration, and engagement with, and understanding of, laryngeal anatomy and vocal health by students in performing arts and speech-language pathology courses.

The Effect of Vocal Hygiene Education Programs on Voice Quality in Professional Voice Users: A Systematic Review

PURPOSE

This study aimed to critically appraise recent peer-reviewed scientific evidence on the effect of vocal hygiene education on voice quality and function directly and indirectly measured by auditory-perceptual, acoustic, and self-report measures in professional voice users.

METHOD

A systematic review was conducted utilizing the Preferred Reporting Items for Systematic review and Meta-Analyses Protocols (PRISMA-P) guidelines. Five databases were searched using the keywords "vocal hygiene," "vocal hygiene education," "vocal health," "vocal quality," and "voice quality" with Boolean phrases "AND" and "OR." Twenty-three studies that met the eligibility criteria were included. Scoring was based on the American Speech-Language-Hearing Association's levels of evidence and quality indicators, as well as the Newcastle-Ottawa Scale for assessing the risk of bias.

RESULTS

Four studies (17%) linked low awareness of vocal hygiene or insufficient vocal hygiene education to self-reported acute and chronic voice symptoms, as well as a greater perception of voice handicap among professional voice users. Numerous studies (n = 10; 43%) showed that adequate voice training or vocal hygiene education was linked to positive voice outcomes. Six studies (6.26%), however, demonstrated that vocal hygiene education is more effective when combined with direct voice therapy. When vocal hygiene education is presented in isolation, the superiority of a direct voice therapy approach, with or without vocal hygiene education, is seen over a vocal hygiene education program alone (indirect treatment).

CONCLUSIONS

Recent literature demonstrates mixed results obtained through auditory-perceptual, acoustic, and self-rating measures on the effects of vocal hygiene instruction on vocal quality and function in professional voice users. However, the compelling positive outcomes presented do warrant implementation of vocal hygiene education programs in combination with direct voice therapy for professional voice users.

Listening to Video Game Voices: A Call for Action for Research into the Vocal Health of Video Game Voice Actors

Video game voice actors (VGVAs) are a professional voice user (PVU) population whose occupation relies on their ability to reliably deliver extremes in vocal performance. In their work VGVAs are required to perform solo for extended durations, producing highly complex character performances that not only include extremes of vocal parameters and qualities but also highly demanding vocal acts (ie, screaming, singing) within those voice archetypes. Based on the vocal demands of their work and current understandings of occupational voice disorder, it is reasonable to consider that VGVAs may be at increased risk of vocal fatigue, injury, and disorder, as manifestations of occupational disease. This risk is of primary concern to VGVAs who recently organized industrial action to highlight their concerns regarding vocal health within their industry. As a group that is not well represented within voice research, there is little literature currently available to inform clinical support of the population. Due to the unique nature of VGVA work and the highly specific nature of occupational voice use among PVUs, we cannot necessarily generalize research from other populations to VGVAs. As such, research utilising frameworks designed to capture the complexity of voice use, demands on the voice, and experiences of its use are required to support the concerns of the population. This paper introduces VGVAs as an emerging PVU population, describes the concerns of this population within the context of current understandings of vocal fatigue, occupational voice problems and PVU populations, and details the approaches required in the development of research into the population.

Voice and Lifestyle Behaviors of Student Singers: Impact of History Gathering Method on Self-Reported Data

OBJECTIVES

This study described voice use and lifestyle information about student singers with a focus on describing differences in self-reported information at study intake compared to data from 21 consecutive days of a voice Log.

METHODS

Twenty-seven student singers estimated voice and lifestyle behaviors at study initiation including daily speaking time, singing/performance time, vocal warm-up, and cool-down minutes; fluid intake; perceived effort when talking, and when singing, among other items. These same parameters were tracked for 21 consecutive days in a voice log kept by the singer at home. Study intake data was compared to the median estimates from the 21-day voice log on each variable using nonparametric statistics.

RESULTS

Student singers reported warming up the voice regularly at study intake (100%), but several logged ≥ 7 days out of 21 without warming up even though all days had singing minutes. Less than half reported voice cool downs at intake, and even fewer logged minutes of cool down in the daily tracking. High occupational voice demands not involving singing were reported by 37%. Large percentages of students reported frustration (63%), worry/anxiety (41%), and depression (26%) regarding their voice in the prior 2 weeks. Estimates at study intake statistically overestimated daily speaking minutes, effort during singing and number of nights eating within 2 hours of sleep compared to the 3-week log.

CONCLUSION

Student singers reported several voice use and behavior items that could impact vocal health. Additionally, how the information was obtained (intake estimate vs. daily log) did alter what was reported for some parameters.

Systems Approaches to Occupational Vocal Health: Considerations for Community Faith Leaders

Systems thinking approaches can benefit the occupational vocal health of vocally reliant workers. This paper explores community faith leaders as an example of a highly vocally reliant occupation, who may benefit from systems thinking being used to support their vocal occupational health and safety. A scoping review of the current literature regarding faith leaders' occupational voice use and vocal health is detailed, including recognised occupational hazards. This article then discusses the unique and potential use of systems thinking for facilitating faith leaders' vocal occupational health and safety. Rather than using a solely clinical perspective, the sociotechnical systems approach and the biopsychosocial-spiritual approach are noted as particularly pertinent for this occupational group.

Vocal Hygiene in Collegiate Singers-Does Formal Training Relate to Practices?

BACKGROUND

Vocal hygiene is vitally important for protecting vocal quality and promoting vocal longevity. It includes adequate hydration, avoidance of environmental irritants, and refraining from phonotraumatic behaviors such as screaming, excessive talking, and throat clearing. Formal singing training in addition to enhancing singing techniques, is also assumed to promote good vocal hygiene. Consequently, we investigated whether collegiate singers with formal training are more likely to practice good vocal hygiene habits than untrained collegiate singers.

METHODS

We completed a prospective cohort study, where collegiate singers at Stanford University were voluntarily enrolled in an annual vocal health clinic. Full laryngeal exams were performed and demographic information, formal vocal training status, and information on vocal hygiene habits were obtained through questionnaires. The results were then analyzed by grouping singers as "untrained" if less than 1 year of formal training, and "trained" if greater than a year.

RESULTS

A total of 82 singers were included for analysis, with 49 (59.8%) having greater than one year of formal training. Trained singers were more likely to employ a primary musical singing style of classical or operatic singing compared to untrained singers who were more likely to utilize "R&B" (P < 0.001). No significant differences were found between groups for hydration practices (P = 0.20), caffeine consumption (P = 0.73), warm up practices (P = 0.08), and phonotraumatic behaviors. Alcohol consumption, smoking tobacco, marijuana, e-cigarette usage was similar between groups. Overall, 11% of our sample reported intermittent less than daily marijuana use, with one singer reporting daily consumption. None of the singers in this sample used e-cigarettes. These rates are noticeably lower than the agematched United States population. Perceptions of cigarettes, marijuana, electronic cigarettes, alcohol, and caffeine were also the same between groups, with the vast majority of singers perceiving these agents as harmful to the voice (64%-100% depending on the agent). No laryngeal pathology was identified during laryngeal examination of any singers.

CONCLUSIONS

Vocal hygiene habits are similar between trained and untrained collegiate singers. This likely relates to a desire for vocal longevity irrespective of prior training. This may dispel the long-held assumption that formal training was necessary to develop good vocal habits. We do however, present a very homogenous, highly educated sample of collegiate singers from Stanford University, having significantly less at-risk behavior than their aged-matched counterparts in the general US population. A lack of laryngeal pathology despite extensive vocal demands may also be reflective of good vocal hygiene habits.

Main reasons that lead popular-music singing teachers to seek speech-language pathology assistance for their students

PURPOSE

To identify the parameters that influences the decision of singing teachers to seek speech-language pathology (SLP) assistance for their students.

METHODS

The study sample comprised 48 popular-music singing teachers, male and female, aged 37.96 years on average. The participants responded to a 10 closed-question questionnaire prepared by the researchers via the SurveyMonkey platform. The questions referred to the reasons why singing teachers seek SLP assistance, as well as to the knowledge of these teachers regarding chronic hoarseness as a risk symptom to identify other lesions in the larynx.

RESULTS

Singing teachers seek SLP assistance for their students in the presence of hoarseness complaints and impaired speech sound articulation. The singing teachers assessed did not consider vocal tiredness complaint as a determining factor for referral to SLP evaluation. Most study participants were not aware that a hoarseness complaint for over 15 days can be indicative of larynx tumor. There was no influence of the variables age and time of professional experience in the referral to SLP assistance.

CONCLUSION

Most of the singing teachers who participated in this study sought SLP assistance for their students when they presented hoarseness complaints and impaired speech sound articulation.