Immediate Impact of Vocal Demand on Musical Theater Singers in Brazil

Vocal Fatigue Experiences and Mitigation Strategies in the Sacred Harp Singing Community

OBJECTIVES

Sacred Harp singers sing at a high volume for sustained periods of time without collective warm-up or cool-down exercises, ostensibly putting them at elevated risk for vocal fatigue (VF) and associated vocal pathologies. Participants are also likely to lack formal vocal training. The purpose of this study was to (1) assess singers' experiences with VF, (2) document singers' strategies for mitigating VF, and (3) determine whether vocal training was associated with decreased vocal difficulties.

STUDY DESIGN

Self-reporting via online questionnaire containing quantitative and qualitative items.

METHODS

This study employed an online questionnaire that combined demographic items, open-ended questions, and the Evaluation of the Ability to Sing Easily (EASE). Participants were recruited at one in-person event and via social media and a mailing list.

RESULTS

This study returned 134 valid responses. Singers with formal choral experience scored lower on the EASE and two subscales, but length of experience had no impact. There were no correlations between vocal training and EASE scores. Women scored higher on the EASE than men and nonbinary individuals, while age, length of experience with Sacred Harp singing, and frequency of attendance at annual singing events were all negatively correlated with EASE score. Singers reported a wide range of mitigation strategies, most of which are unique to the Sacred Harp context.

CONCLUSIONS

Sacred Harp singers do not appear to struggle more with VF than other populations of singers. However, a few characteristics of their practice put them at risk, and many singers would benefit from professional guidance concerning vocal health.

Vocal Self-Perception of Singers During COVID-19 Pandemic

OBJECTIVE

to compare the self-perception of vocal fatigue and use of singing voice during the COVID-19 pandemic between professional and amateur singers and to relate this self-perception with vocal use characteristics during this period.

METHODOLOGY

Participants were 121 singers divided into professional singers group (PSG) (12 men and 20 women) comprising singers who depended exclusively on singing as a profession and an amateur singers group (ASG) (37 men and 52 women) of singers who did not depend exclusively on singing for their livelihood. All answered online questionnaires through Google Forms ®. Sociodemographic and vocal characteristics were investigated before and during the pandemic; symptoms of vocal fatigue were assessed through the vocal fatigue index (VFI); and self-perception of use of singing voice through the evaluation of the ability to sing easily protocol for Brazil (EASE-Br).

RESULTS

In the comparison between groups, the PSG presented higher scores of vocal fatigue in fatigue and vocal limitation (P = 0.045), vocal restriction (P = 0.002), and recovery with vocal rest (P = 0.008) domains than did the ASG. There was no difference between the groups regarding the use of singing voice. Based on the relationship between self-perception and vocal use characteristics during the pandemic, it was observed that the presence of vocal complaint was the only factor associated with self-perception of fatigue symptomatology in both groups. Regarding the self-perception of the current status of the singing voice, singing time, the presence of vocal complaints, the need to increase visual concentration, and the perception of vocal worsening during the pandemic were considered predictive for amateur singers. For professional singers, vocal complaints and vocal training were predictors for self-perception of the current status of the singing voice.

CONCLUSION

Professional singers presented with higher scores of vocal fatigue than did amateur singers. The symptomatology of vocal fatigue was associated with the presence of vocal complaints in both groups. However, self-perception of the current status of the singing voice was different between the groups and was associated with vocal training for professional singers and characteristics of vocal demand of singing voice during the pandemic period for amateur singers.

Systematic Review of Literature on Vocal Demand Response: Understanding Physiology, Measurements, and Associated Factors

PURPOSE

Considering the conceptual migration from vocal load and vocal loading to vocal demand and vocal demand response, this review of literature aimed to identify physiological explanations, reported measurements, and associated factors (vocal demands) reported in the literature when considering the phonatory response to a vocal demand.

METHODS

A systematic review of literature, following the PRISMA Statement, was conducted using Web of Science, PubMed, Scopus, and ScienceDirect. Data were analyzed and presented in two parts. First, a bibliometric analysis, co-occurrence analysis, and content analysis were performed. Three criteria that got article inclusion were defined: (1) written in English, Spanish, and Portuguese; (2) published between 2009 and 2021; and (3) focused on vocal load and loading, vocal demand response, and voice assessment parameters. A total of 54 publications met the criteria and were included in this review. The second part included a conceptual framework based on the content analysis of three aspects of vocal demand response: (1) physiological explanations, (2) reported measurements, and (3) vocal demands.

RESULTS AND CONCLUSION

As would be expected since vocal demand response is a relatively new term and not yet commonly used in literature when discussing way that the speakers respond to communicative scenarios, most of the studies reviewed (both historical and recent) still use the term of vocal load and vocal loading. Although there is a broad variety of literature discussing a wide range of vocal demands and voice parameters used to characterize the vocal demand response, results show that there is consistency across the studies. While vocal demand response is unique and intrinsic to the talker, associated factors that contribute to this response include both internal talker and external talker factors. Internal factors include muscle stiffness, viscosity in the phonatory system, vocal fold tissue damage, elevated sound pressure levels during occupational voice demands, extended periods of voice use, suboptimal body posture, difficulties in breathing technique, and sleep disturbances. Associated external factors include the working environment (noise, acoustics, temperature, humidity). In conclusion, although vocal demand response is intrinsic to the speaker, the speaker's response is affected by external vocal demands. However, due to the wide methods to evaluate vocal demand response, it has been difficult to establish its contribution to voice disorders in the general population and, specifically, among occupational voice users. This literature review identified commonly reported parameters and factors that may help clinicians and researchers define vocal demand response.

Self-reported Vocal Demands, Perceptions, and Knowledge of Occupational Voice Users in South Africa

OBJECTIVES

The study aimed to describe daily vocal demands, perceptions and knowledge as reported by occupational voice users.

STUDY DESIGN

A descriptive, cross-sectional research design was employed.

METHODS

A survey on vocal demands, perceptions and knowledge was distributed to 102 occupational voice users via a snowball sampling technique.

RESULTS

Slightly more than half of the participants (55%) reported using their voice for work 36.5 hours a week on average (SD = 15.5, range: 33-40). Participants reported that, on average, their daily voice use is 6.3 hours (SD = 2.7) for work and the majority (81%) reported a decrease in voice quality after work; Three-quarters (75%) also reported vocal fatigue at the end of day. Approximately one-third (33%) reported being exposed to environments where they are expected to shout, scream or cheer loudly. More than half of the participants (61%) reported that they have previously received vocal health education but 40% reported that they felt this training was insufficient. High vocal demands are significantly correlated to an increase in perceived vocal handicap rs = 0.242; (P = 0.018), tiredness of voice rs = 0.270; (P = 0.008), physical discomfort rs = 0.217; (P = 0.038) as well as how occupational voice users experience improvement of symptoms with rest rs = -0.356 (P < 0.001). Other risk factors highlighted by occupational voice users are the ingestion of liquid caffeine, alcohol, and carbonated drinks, smoking or the presence of chronic cough, chronic laryngitis, and gastroesophageal reflux disease.

CONCLUSIONS

Occupational voice users are subjected to high daily vocal demands that can be seen to be linked to vocal fatigue, changes in voice quality and vocal symptoms experienced. It is essential that occupational voice users as well as treating clinicians are aware of certain significant predictors of both vocal handicap and vocal fatigue. These findings provide insights for developing strategies for training and cultivating vocal health consciousness and preventive voice care initiatives that focus on occupational voice users in South Africa.

Immediate Effects of Straw Phonation in Water Exercises on Parameters of Vocal Loading in Carnatic Classical Singers

OBJECTIVE

The present study aimed to investigate the effect of vocal loading and the immediate effects of straw phonation in water exercises on parameters of vocal loading in Carnatic classical singers.

STUDY DESIGN

A within-subject pretest-posttest design.

METHODS

Twelve healthy Carnatic classical singers participated in the vocal loading experiment for 2 days, referred to as no-treatment and treatment conditions. The vocal loading task consisted of 1 hour of continuous singing in the presence of background noise. For the treatment condition, the participants followed a 10-minute straw phonation in water exercises before the vocal loading task. Acoustic, electroglottographic, and self-rated perceptual voice measures were recorded before and after the vocal loading task on both days.

RESULTS

Pretest and posttest comparison of various outcome measures during no-treatment day suggested a significant increase in shimmer percent, decrease in maximum phonation duration of vowel /a/, and increase in perceived phonatory effort, perceived vocal effort, and Evaluation of Ability to Sing Easily scores. Pretest and posttest comparisons during treatment day showed a significant increase in Mean F0, Highest F0, and Lowest F0, perceived phonatory effort, and perceived vocal effort scores. However, changes in Mean F0, Highest F0, and Lowest F0 measures were small in the posttest condition compared to pretest.

CONCLUSION

The present results suggest that vocal loading did induce changes in Carnatic classical singers' voices. However, there is no substantial evidence that straw phonation is effective in reducing the vocal loading in Carnatic classical singers. Further studies are required to corroborate the current findings.

Vocal Quality, Symptoms, and Habits in Musical Theater Actors

PURPOSE

The purpose of this study was to measure and compare the voice characteristics and vocal complaints and habits of musical theater actors and musical theater students.

METHOD

Thirty participants were included in the study, 18 musical theater students and 12 professional musical theater actors. Vocal quality was measured by the multiparameter indices Dysphonia Severity Index (DSI) and Acoustic Voice Quality Index (AVQI). A perceptual evaluation of the speaking voice was performed using the GRBASI scale. All participants completed the Voice Handicap Index (VHI), the VHI adapted to the singing voice, the Vocal Tract Discomfort (VTD) Scale and the Corporal Pain Scale.

RESULTS

Excellent scores for DSI (resp. 7.3, 7.1) and AVQI (resp. 2.6, 2.5) were found in the musical theater actors and students. All participants reported at least two symptoms of VTD and the mean scores for the VHI adapted to the singing voice were located in the clinical zone. Musical theater students reported significantly more VTD and pain symptoms compared to the professionals. No significant differences in perceptual and objective voice characteristics were found between musical theater actors and students. A higher presence of vocal misuse and stress in the students was observed.

CONCLUSION

Musical theater students and actors are elite vocal performers with comparable excellent objective vocal measures (DSI, AVQI). In both groups, an increased number of VTD and complaints of the singing voice were reported. Especially students were vulnerable for stress, vocal misuse, VTD, and pain symptoms. The findings suggest that musical theater actors are a risk group for developing voice disorders requiring multidimensional voice assessment and voice care.

Vocal Quality After a Performance in Actors Compared to Dancers

STATE OF THE ART

Theater actors are a high risk group for developing voice disorders.

AIMS

The first purpose of this study was to examine and compare the objective and subjective vocal quality between professional theater actors, non-professional theater actors and a control group of professional dancers. Secondly, the impact of one theater performance on the objective and subjective vocal quality was investigated within and between the groups. It is hypothesized that actors will experience vocal fatigue and a deteriorated vocal quality compared with dancers as a result of the vocal load during the performance. Dancers will face more general fatigue and smaller vocal changes due to the impact of a performance including stress, decompensation and physical fatigue.

METHODS

Recordings of 27 professional actors, 19 non-professional actors and 16 professional dancers were collected before and after a performance using the PRAAT software. Voice samples included sustained vowel phonation, continuous speech, aerodynamic measurements and voice range profile. Both Acoustic Voice Quality Index and Dysphonia Severity Index were computed. For auditory-perceptual evaluations the GRBASI scale was used. Several questionnaires were completed pre and post performance to capture vocal risk factors.

RESULTS

Vocal quality between groups showed lower fundamental frequency (f_o) values (female), larger fundamental frequency (female) and intensity ranges and a longer maximum phonation time (female) in professional actors compared to non-professionals. Professional dancers showed higher Acoustic Voice Quality Index values compared to non-professional actors. Dysphonia Severity Index, Voice Handicap Index, Vocal Tract Discomfort Scale and GRBASI results did not differ between groups at the baseline. Both objective measurements and questionnaires did not show significantly different results post performance. Questionnaires revealed poor vocal habits in professional actors.

CONCLUSION

Professional actors have better vocal capacities than non-professionals. Dancers' vocal quality is worse than actors. The results show no impact of one performance on the vocal quality in theater actors and dancers. The long-term impact of performing, however, is subject for further research.

Occupational voice is a work in progress: active risk management, habilitation and rehabilitation

The current article reviews recent literature examining occupational voice use and occupational voice disorders (January 2018–July 2019).

Expressiveness of voice professionals: construction process of a speech-language pathology assessment script

PURPOSE

To create a consensus version of a speech-language pathology (SLP) script to assess the expressiveness of voice professionals.

METHODS

The process was divided into three stages: stage 1 included a survey of the literature and classification of the variables found in the instruments used; in steps 2 and 3, through teamwork, expert judges (focus groups I and II) created and adapted, along with the researcher, a consensus version of the expressiveness assessment script.

RESULTS

The initial list presented to the judges contained 48 variables found in the literature: 11 related to emotional and interpretation aspects, 20 associated with oral expressiveness, three related to issues of verbal expressiveness, and 14 related to nonverbal expressiveness. In stage 2, the initial version of the script of the focus group I resulted in a document with 28 parameters, distributed in three thematic assessment groups: general aspects of communication, with three parameters; aspects related to oral expressiveness, with 16 parameters; aspects associated with body expressiveness, with nine parameters. In stage 3, after adequacy by focus group II, the consensus version also resulted in 28 parameters, distributed in two thematic groups.

CONCLUSION

The consensus version of the SLP expressiveness assessment script for voice professionals was finalized with 28 parameters, distributed in two thematic axes: initial impact of communication, with six parameters; expressiveness, with 22 parameters.

Cross-Cultural Adaptation and Validation of the Evaluation of the Ability to Sing Easily (EASE) for Kannada-Speaking Carnatic Classical Singers

OBJECTIVE

The present study aimed to cross-culturally adapt and validate the Evaluation of the Ability to Sing Easily (EASE) into Kannada for the benefit of Carnatic classical singers.

METHODS

Following a standard translation procedure, the original English version was translated to develop a prefinal EASE-K version. This was further field-tested on 12 Carnatic singers to obtain the final EASE-K version. Upon validating the same on 104 Carnatic singers, intercorrelation between EASE-K subscales- Vocal Fatigue (VF) and Pathologic Risk Indicators (PRI) were assessed using the Spearman correlation coefficient. The internal consistency of the subscales was obtained based on the Cronbach's alpha coefficient. Nonparametric tests were carried out to study the effect of age and gender on EASE-K subscales. Further, the raw scores of the English version were compared to the EASE-K.

RESULTS

Spearman correlation coefficient indicated a statistically significant positive correlation (P < .01) between the two subscales (r = .745). Each scale showed good internal consistency (Cronbach's alpha was .84). Test-retest reliability carried on 12 singers indicated an excellent reliability for the subscales. Nonparametric tests indicated no significant effect of age and gender on the subscales of EASE-K (P > .05). Comparison across the original and EASE-K revealed significant differences for both VF (P = .02) and PRI (P = .00) subscales.

CONCLUSIONS

Current findings indicate that EASE-K is a reliable and valid tool that can be used to document the subtle changes in voice in healthy Carnatic classical singers. Further, the current tool can be used to study the effect of vocal loading across different singing styles.