Independence of Vocal Load From Vocal Pathology Across Singing Genres

Reflux Disease in Singers: A Systematic Review

OBJECTIVE

To investigate the laryngopharyngeal reflux disease (LPRD) features in singers.

METHODS

According to the PRISMA statements, two investigators searched the literature related to the prevalence of symptoms, findings, and clinical therapeutic outcomes of reflux in singers through a PubMed, Scopus, and Cochrane Library systematic review.

RESULTS

Of the 91 identified studies, 18 publications met the inclusion criteria, accounting for 2288 singers and 1398 controls, respectively. There were 1243 (54.3%) professional singers, 450 (19.7%) amateurs, 329 (14.4%) singing students, and 102 (4.5%) singing teachers. The LPRD diagnosis and findings were based on objective evaluations in 2/18 studies. According to validated and unvalidated patient-reported outcome questionnaires, reflux symptoms have been found in 25.0% to 65% of singers, with a RSI > 13 in 25.0%-33.9% of cases. The prevalence of LPRD signs ranged from 18.1% to 73.4% of singers without voice complaints and 18.1%-73.4% of singers with voice complaints at the time of the evaluation. No study investigated the pretreatment to post treatment changes in symptoms, findings, and voice outcome. Substantial heterogeneity was found between studies for reflux diagnosis, symptom and sign evaluations, singer profiles (musical styles, voice range), and association outcomes.

CONCLUSION

The prevalence of symptoms and findings attributed to LPRD can be high in singer populations. However, the nonspecificity of symptoms and findings, the lack of objective reflux testing, and the heterogeneity in the singer profile limit the drawing of valid conclusions for the prevalence of LPRD. Based on the findings collected in this systematic review, the authors proposed a semistructured questionnaire, including key points for primary singer evaluation.

The Vocal Hygiene Treatment Programs for Singers: A Systematic Review

OBJECTIVES

This systematic review aims to explore the effectiveness of voice health education interventions among singers, particularly focusing on vocal hygiene treatment programs tailored for professional voice users.

STUDY DESIGN

Systematic review.

METHODS

Preferred Reporting Items on Systematic Reviews and Meta-Analysis guidelines were followed to conduct this systematic review. Comprehensive searches were conducted in PubMed, Web of Science, Scopus, Science Direct, and Cochrane Library databases. Four articles were selected for detailed review. The studies were evaluated using the Effective Public Health Practice Project tool for quality assessment.

RESULTS

The four reviewed studies primarily utilized the pretest-posttest design to examine the effectiveness of vocal hygiene interventions on singers' vocal health. Two studies investigated the effect of hydration as a treatment method, while the remaining two focused on vocal hygiene instruction. Significant improvements were observed in various vocal health parameters, including maximum phonation time, intensity, Dysphonia Severity Index, and number of daily vocal breaks taken.

CONCLUSION

This systematic review provides valuable insights into the efficacy of vocal hygiene treatment programs for singers. The positive outcomes observed in the reviewed studies underscore the importance of voice health education tailored to singers' specific needs. However, the limited number of eligible studies and the common limitation of small sample sizes highlight the need for further research in this area. Vocal health practitioners, educators, and researchers can utilize the findings of this review to develop evidence-based vocal hygiene interventions that promote the well-being and longevity of singers' vocal performance careers.

Vocal Fold Pathologies Among Undergraduate Singing Students In Three Different Genres

OBJECTIVE

This study aimed to compare the prevalence and incidence of vocal fold pathologies among undergraduate classical, musical theatre, and contemporary commercial music (CCM) students over two-time points.

METHODS

This study is part of a longitudinal investigation. Videostroboscopic examinations were rated, with consensus among three of four expert blinded raters confirming the presence of pathology. Association between genre of singer and the presence of pathology, interrater reliability, and intra-rater reliability were calculated. Prevalence and incidence of pathologies were compared across genres.

RESULTS

During first-year evaluations, 32% of musical theatre, 18% of CCM, and 0% of classical students had vocal pathologies. The prevalence at third-year evaluations showed 22% of classical, 39% of musical theatre, and 27% of CCM participants having vocal fold pathologies. The incidence of pathologies was 67% of musical theatre students compared to 22% of classical students and 27% of CCM students. The four raters demonstrated fair to moderate interrater agreement. Singing Voice Handicap Index-10 scores were normal for CCM singers at both time points but elevated for musical theatre and classical singers.

CONCLUSION

No classical singers were found to have pathology during first-year evaluations, although CCM and musical theatre singers showed evidence of vocal fold pathologies. At third-year evaluations, all three genres had an apparent increase in prevalence of pathologies. Implications of this study suggest that more time in the field and intense voice usage may lead to a greater risk of pathology for all singers, regardless of genre.

LEVEL OF EVIDENCE

2 Laryngoscope, 133:2317-2324, 2023.

Association of Genre of Singing and Phonotraumatic Vocal Fold Lesions in Singers

OBJECTIVES/HYPOTHESIS

To determine if (1) the likelihood of presenting with phonotraumatic lesions differs by singing genre in treatment-seeking singers and (2) if the distribution of phonotraumatic lesion types differs by singing genre.

STUDY TYPE

Retrospective.

METHODS

Records of singers who presented with a voice complaint over the course of 2.5 years (June 2017-December 2019) were reviewed to determine the proportion of those with phonotraumatic lesions as a function of genre (Study 1). Separately, the lesion types and genres of singers diagnosed with phonotraumatic lesions over a 9-year period (July 2011-March 2020) were determined (Study 2).

RESULTS

In Study 1, 191 of 712 (26.8%) dysphonic singers were diagnosed with phonotraumatic lesions. Country/folk, gospel/jazz, and musical theater singers were more likely to present with phonotraumatic lesions. In Study 2, in 443 singers with phonotraumatic lesions, polyps and pseudocysts, but not nodules, were found to be distributed unequally across genres (χ² p = 0.006, p < 0.0001, p = 0.064, respectively). Praise/worship singers had significantly higher proportions of polyps compared to choral singers (OR 4.8 [95% CI 1.9-12.5]) or compared to musical theater singers (OR 7.2 [95% CI 2.5-20.8]). Opera singers had significantly higher proportions of pseudocysts than choral singers (OR 3.1 [95% CI 1.5-6.1]) or musical theater singers (OR 3.7 [95% CI 1.8-7.6]).

CONCLUSIONS

The higher incidence of polyps in praise/worship singers likely reflects the more emphatic nature of singing and the tendency for acute injury. The higher incidence of pseudocysts in opera singers may reflect a more chronic nature of injury.

LEVEL OF EVIDENCE

4 Laryngoscope, 2023.