Measuring vocal function in professional music theater singers: construct validation of the Evaluation of the Ability to Sing Easily (EASE)

Vocal Health Assessment of Professional Performers Returning to the Stage After the COVID-19 Pandemic Shutdown

OBJECTIVES/HYPOTHESIS

This study assessed the vocal health of performers returning to full-time performance after the COVID-19 pandemic shutdown and investigated how differences in voice usage, exposure to voice care professionals, and vocal pathology before and during the pandemic contributed to variability in self-perceived and instrumental vocal outcome measures.

STUDY DESIGN

This was a prospective, case-control observational study conducted at a single outpatient site.

METHODS

Twenty-two patients, 11 cases and 11 controls, were enrolled for the study. All participants were full-time singing professionals prior to the COVID-19 pandemic. Cases were recruited from patients presenting to a tertiary care voice center for vocal or pharyngeal complaints. Controls were healthy volunteers recruited from the general population of professional singers in the surrounding metropolitan area. All participants provided responses to the Voice Handicap Index-10, Evaluation of Ability to Sing Easily, and Laryngopharyngeal Measure of Perceived Sensation validated questionnaires as well as a study survey with questions regarding vocal use and history prior to and during the pandemic. All participants underwent instrumental acoustic and videostroboscopic voice evaluations.

RESULTS

Cases had poorer outcome measures overall and were more likely to report their voices were worse at study enrollment when compared to their prepandemic perception (P = 0.027). Cases tended to be older and less likely to have pursued alternative employment during the pandemic that involved increased speaking voice use (27% vs 55%), but these differences were not statistically significant.

CONCLUSIONS

There was a variable response among performers to the prolonged hiatus from performing during the COVID-19 pandemic. Those with poorer outcomes tended to be older and may have used their voice less during the pandemic. These findings are consistent with detraining periods in the exercise physiology literature and support the construct of treating vocal performers as vocal athletes.

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.

Performers With History of Voice Injury: A Survey Study of Treatment Outcomes and Vocal Function

INTRODUCTION

Past studies show that performers are more susceptible to voice injury, have higher incidence of injury, and experience greater vocal impairment than non-performers. Despite literature demonstrating otherwise, there remains fear and stigma that voice injury is a career-ending circumstance. Much of this is due to a lack of information about post-treatment vocal function.

METHODS

An anonymous online survey was distributed via email, flyer, and social media to a target audience of performers with a history of voice injury. It inquired about occupation, vocal symptoms, professionals consulted, and treatment adherence. Outcome measures included ability to perform, resolution of symptoms, and attitudes about their voices after voice injury. Findings were analyzed descriptively with statistical analysis to determine factors that may be related to favorable outcomes.

RESULTS

The survey was completed by 151 performers representing a range of genres, including musical theatre, classical, and popular genres. The most reported vocal symptoms were decreased range, singing voice quality changes, increased singing effort, and vocal fatigue. Most initially sought care from an otolaryngologist, laryngologist, or voice teacher. Diagnoses and recommendations varied, but those who adhered to treatment were more likely to report resolution of voice symptoms (P = 0.025). Those with symptoms for 2-4 weeks reported greater vocal confidence than those with a longer symptom duration (P = 0.0251). Performers working with a voice teacher were more likely to find treatment helpful (P = 0.0174). Those with neurogenic voice conditions reported less vocal reliability than participants with other pathologies (P = 0.0155).

CONCLUSION

The majority of participants continued to perform, reported resolved or improved voice symptoms after treatment, and reported positive attitudes about their voices, regardless of their injury or current presence or absence of pathology on exam. Findings of this study highlight a need for continued outreach to voice teachers, education programs, and production teams about vocal function after voice injury.

LEVEL OF EVIDENCE: 4

Reducing Vocal Fatigue While Preserving Realism During Video Game Voice-Overs Using the Vocal Combat Technique: A Randomized Controlled Trial

OBJECTIVE

Vocal Combat Technique (VCT) teaches indirect and direct behavioral voice techniques to voice-over artists performing in violent video games. Although previous work on VCT has shown promise for mitigating dysphonia symptoms, a randomized clinical trial has yet to be undertaken. Therefore, we completed a randomized, controlled trial between a group of experienced video game voice-over actors receiving VCT and a control group comparison.

METHODS

A total of 24 video game voice-over actors completed this study. Participants were randomly assigned to receive VCT or indirect vocal hygiene training prior to completing an intensive 1-hour video game voice recording session. The primary outcome was a change in Voice Handicap Index-10 (VHI-10) preperformance/postperformance. Secondary measures included a modified version of the Evaluation of the Ability to Sing Easily (m-EASE), the Vocal Tract Discomfort Scale (VTDS), and questions regarding return to work. Participants were also rated on the realism of their vocal performance by a blinded video game director.

RESULTS

The VCT group showed a significantly smaller change in VHI-10 and m-EASE scores postperformance, and a higher increased likelihood to return to work compared to the control group. There were no group differences for VTDS or realism ratings. Four participants from the control group exhibited outlier behavior with more pronounced phonotraumatic symptoms following performance than all other participants.

CONCLUSIONS

VCT shows evidence of mitigating symptoms of dysphonia while preserving the realism of the vocal performance. More work is needed to understand performers at risk for more severe vocal symptoms following extreme voice-over work, so as to target them for preventative techniques and voice preservation.

It Sounds like It Feels: Preliminary Exploration of an Aeroacoustic Diagnostic Protocol for Singers

To date, no established protocol exists for measuring functional voice changes in singers with subclinical singing-voice complaints. Hence, these may go undiagnosed until they progress into greater severity. This exploratory study sought to (1) determine which scale items in the self-perceptual Evaluation of Ability to Sing Easily (EASE) are associated with instrumental voice measures, and (2) construct as proof-of-concept an instrumental index related to singers' perceptions of their vocal function and health status. Eighteen classical singers were acoustically recorded in a controlled environment singing an /a/ vowel using soft phonation. Aerodynamic data were collected during a softly sung /papapapapapapa/ task with the KayPENTAX Phonatory Aerodynamic System. Using multi and univariate linear regression techniques, CPPS, vibrato jitter, vibrato shimmer, and an efficiency ratio (SPL/PSub) were included in a significant model (p < 0.001) explaining 62.4% of variance in participants' composite scores of three scale items related to vocal fatigue. The instrumental index showed a significant association (p = 0.001) with the EASE vocal fatigue subscale overall. Findings illustrate that an aeroacoustic instrumental index may be useful for monitoring functional changes in the singing voice as part of a multidimensional diagnostic approach to preventative and rehabilitative voice healthcare for professional singing-voice users.

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.

Effects of Participation in a Structured Choral Program on the Voice of Older Adults

OBJECTIVES

To examine the effects of short-term and long-term engagement with structured choral singing on vocal function and quality of life outcomes in older adults.

METHODS

Two groups of older adult singers over 55 years, one with fewer than 4 semesters and one with 4 or more semesters singing in a chorale, were assessed at 3 time points: baseline, after 1 semester of singing, and either after 1 semester of rest or after 1 semester of rest and 1 semester more of singing. Acoustic and aerodynamic measures, voice-related quality of life ratings, and measures of singing accuracy were obtained. Percent change between time points were calculated to determine three outcomes: improvement, lack of change, or worsening of measures across time.

RESULTS

Long-term average spectrum (LTAS), difference in first and second harmonics and estimated subglottic pressure were significantly more likely to improve after a semester of singing with less experience singers, and LTAS continued to improve after a semester of rest. Flow was significantly more likely to improve with more singing experience after a semester of singing. Aerodynamic variables consistently changed in more experienced singers and improvement was maintained over the three visits. No significant changes occurred over time for singing accuracy for any singer type. Self-perception of singing voice continued to improve with more singing experience.

CONCLUSIONS

This study demonstrated that for older adults in good health, regular singing provided a mechanism for maintaining speaking voice over time.

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.

EASE-NL: Cross-Cultural Adaptation and Validation of the Dutch Version of the Evaluation of Ability to Sing Easily

OBJECTVES

The Evaluation of the Ability to Sing Easily (EASE) is a self-rating tool that is used to assess the singer's perceptions of the current singing voice status. The purpose of this study was to develop and validate a Dutch translation of the EASE.

METHODS

The original version of the EASE was translated and adapted to Dutch according to the recommendations of the Quality of Life Special Interest Group - Translation and Cultural Adaptation group. Subsequently, the questionnaire was individually completed by 70 singers with a mean age of 35.2 years before and after a singing activity, together with a demographic questionnaire and the Dutch Singing Voice Handicap Index 10 (SVHI-10-NL). Two groups of singers were included between September and June 2020: a group of healthy singers (n = 54) and a group of dysphonic singers (n = 16). Internal and external consistency, construct and criterion validity, test-retest and split-half reliability were calculated using Cronbach's alpha coefficients, Student's t-test, the paired Wilcoxon tests and Pearson correlation coefficients. Furthermore, the impact of sex and age and the diagnostic accuracy of the EASE-NL was measured using the Mann Whitney U-test, the One Way ANOVA and the Brown Forsythe ANOVA-test.

RESULTS

The internal consistency of the EASE was considered good. For the external consistency, the Pearson correlation coefficient showed a positive correlation between the total score of the EASE-NL and the SVHI-10-NL. Dysphonic singers scored significantly higher compared to singers without voice problems and no differences were found between the pre and post singing condition in both groups. Pearson correlations coefficients showed a strong positive correlation between the test and retest condition and between the subscales. A ROC-curve analysis showed a cut-off score of 12.5, with a sensitivity level of 75.0% and a specificity level of 74.1%. No differences for sex and age were found.

CONCLUSIONS

The original English version of the EASE was translated and validated in Dutch. The EASE-NL is found to be a valid and reliable self-reported tool to assess singer's perceptions of the current status of their singing voice.

Mitigating Dysphonia, Pain, and Vocal Handicap after Violent Video Game Voice Overs: A Pilot Investigation into Vocal Combat Technique Training

OBJECTIVE

to investigate how the Vocal Combat Technique (VCT) may mitigate vocal symptoms in voice over actors using vocal violence.

METHODS

Five voice over actors (3 male, 2 females, Mean = 29.6 years) completed two study sessions of 45 minutes-to-1 hour of vocally violent voice over work held approximately 4 weeks apart. During session one, participants completed voice over work as they typically would, whereas they received 3-hours of VCT training to improve/assist in healthy vocal techniques prior to session two. Pre- and post-session measures for both sessions included self-perceptual ratings of vocal symptoms, auditory-perceptual evaluation, and traditional acoustic measures of frequency and perturbation.

RESULTS

Participants showed substantial mitigating effects of VCT training on acoustic perturbation measures (jitter, shimmer, harmonics-to-noise ratio), and self-ratings of vocal symptoms (Vocal-Handicap Index-10, McGill Pain Scale for vocal discomfort, and Evaluation of the Ability to Sing Easily) with calculated medium to large effect sizes (d = 0.61-1.95). There were no changes in auditory perceptual ratings across sessions.

CONCLUSION

Our pilot investigation yielded positive improvements in vocal symptomology in five voice over actors who were trained in VCT. Next steps should include a larger enrollment of voice actors to determine optimal preventative and recovery techniques.

The Impact of Fish Oil Supplementation on Self-Perception of the Voice in Vocal Performers: A Randomized, Single-Blind, Placebo-Controlled Study

PURPOSE

Physically active adults have experienced training benefits from fish oil-derived omega-3 fatty acid (FO n3), which may also be of benefit to singers. The purpose of this research study was to determine if self-reported vocal adaptations and body composition changes occur in singers following FO n3 supplementation in conjunction with a singer's normal training regimen.

METHOD

Twenty college students, currently enrolled in vocal lessons at a university, were randomized to receive either 3.0 g of FO n3 or placebo, which they took during a 10-week study period. Participants were blinded to group assignment. Participants completed the Reflux Symptom Index (RSI), Singing Voice Handicap Index-10 (SVHI-10), and the Evaluation of Ability to Sing Easily (EASE) and submitted to body composition measures (weight, skeletal mass, and body fat mass) before and after the study period.

RESULTS

Sixteen participants completed all parts of the study protocol. Mean compliance for the placebo group (83.9%) and the supplement group (75.2%) was similar. There were no significant differences in body composition measures, RSI scores, and EASE scores between groups. Scores on the SVHI-10 decreased significantly over time for all participants.

CONCLUSIONS

Improvements seen in the SVHI-10 were not meaningfully different between the supplement and placebo group, pointing to the benefit of weekly lessons. The lack of changes in the questionnaire scores in the supplement group are partially attributed to the low compliance rate and low sample size, which is supported by the lack of change in the body composition measures.

Self-rated vocal complaints relationship to Vocal Tract Discomfort and Singers Voice Handicap Index in Iranian religious singers

PURPOSE

The religious singing is a popular group of professional voice users in Iran which is performed in a sadness form to persuade the audiences to cry and think to holy persons. This style has its own unique vocal demands and abuses. Therefore, the present study, for the first time, aimed to investigate the prevalence of self-reported vocal complaints, vocal discomfort symptoms, and its effects on the vocal-related life of the Iranian religious singers.

METHODS

In a cross-sectional study, 62 religious singers (28 women, 34 men) completed Singers Voice Handicap Index (SVHI), Vocal Tract Discomfort (VTD), and also a non-standard self-rated vocal complaint question. Spearman correlation test was applied to analyze correlations. Furthermore, 39 non-singers (18 women, 21 men) as a control group participated in this study.

RESULTS

The religious singer's mean score of the SVHI test was 34.84 (SD = 24.89). According to the self-rated vocal complaint question, almost 80% of the participants reported mild to the severe vocal complaints that was significantly higher than control group which was about 10%. The self-rated complaints indicated a significant positive correlation with the SVHI and the VTD reported by singers (p ≤ 0.001). The mean scores of the VTD symptoms in singers were significantly greater than control group. There was also a significant positive correlation between the two VTD and SVHI tests (p ≤ 0.001).

CONCLUSION

Religious singers are at a great risk of developing voice problems. Therefore, their vocal demands and requirements need to be followed precisely. The SVHI and VTD tests should also be considered as two efficient tools for religious singers.

Quantifying Subjective and Objective Measures of Singing After Different Warm-Up Durations

BACKGROUND

Performing vocal warm-ups prior to singing repertoire has been shown to change the perceived quality and acoustic parameters of the voice. To date, there are no studies that specifically compare singers' and listeners' perceptions of vocal quality after various warm-up durations.

OBJECTIVE

To determine if specific warm-up durations (0, 5, 10, or 15 minutes) change subjective and objective measures of voice.

STUDY DESIGN

Prospective cohort study.

METHODS

Information related to demographics, singing practice, medical history, and vocal hygiene were collected. First- and second-year collegiate classical voice majors completed a series of four warm-up times, 1 week apart, prior to singing Caro mio ben in a standard key for their voice type. A modified Voice Range Profile (mVRP), and the Evaluation of the Ability to Sing Easily (EASE) scale were completed. Participants blindly rated 30-second recorded audio clips using the Auditory-Perceptual Rating Instrument for Operatic Singing. Four independent expert blinded listeners rated all audio clips for each participant in random order.

RESULTS

Six first-year and three second-year classical vocal performance majors completed all measures. Results of the EASE scale showed decreased scores with 5- and 10-minute warm-up duration, compared to 0 and 15 minutes of warm-up (P = 0.029 for the total EASE score and P = 0.044 for Rasch score). Delayed perceptual analysis of voice yielded nearly equal medians between warm-up durations for both self and expert-listener ratings. The mVRP showed that both 5 and 10 minutes of warm-up duration led to increased highest fundamental frequency for females (P = 0.017).

CONCLUSION

This pilot study demonstrates the immediate self-perceived benefit for all participants and increased frequency range for females after performing 5 and 10 minutes of vocal warm-up. No significant differences were found in delayed perceptual analyses completed by the participants or the expert raters after the different warm-up durations. Future investigations should include a larger population and different levels of education and genres of singing.

Amateur Music Theatre Singers' Perceptions of their Current Singing Voice Function

PURPOSE

The primary aim of this study was to investigate amateur music theatre singers (MTS)' perceptions of their current singing voice function according to evaluation of ability to sing easily (EASE) scores while involved in a musical theatre production, to determine if scores were influenced by demographic or voice-related factors and to compare EASE scores of amateur MTS and previously published professional MTS.

METHOD

Amateur singers were recruited through the Townsville Choral Society during the preproduction of Les Misérables. A total of 51 amateur MTS completed an online questionnaire including the EASE scale and a supplementary demographic questionnaire. Nonparametric statistical analyses were conducted.

RESULTS

Three singers reported they had a voice problem at the time they completed the questionnaire. The EASE did not detect significant differences in perceived vocal function among the singers according to demographic (age and gender) and voice-related characteristics. The amateur cohort reported lower current voice-use demands, such as current vocal load and number of shows over past week, than the previously described professional MTS and no significant differences were found between the two cohorts in the median EASE scores.

CONCLUSIONS

The results of this study supported both the overall validity of the EASE scale and its use with amateur MTS. In addition, the findings suggest the value of future research investigating the potential use of the EASE for broader clinical application with other population groups.

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.

Associations of Education and Training with Perceived Singing Voice Function Among Professional Singers

BACKGROUND

The educational backgrounds of professional singers vary greatly and span from no formal training to advanced degrees in music or theater. Consequently, professional singers have a wide range of knowledge regarding basic voice care. The objective of this study was to examine associations between singers' educational backgrounds, specifically their knowledge of vocal pedagogy and awareness of vocal health, and their perceptions of their current vocal function associated with singing.

STUDY DESIGN

Cross sectional survey.

METHODS

An online survey was distributed nationwide to over 1,000 self-identifying as a professional singer working full time as a performer. The survey included 54 questions about their background education, performance history, years of professional experience, affiliation to a professional union, general health and wellness, and the Evaluation of the Ability to Sing Easily (EASE), a 20-item scale to assess singers' perceptions of the current status of their vocal function.

RESULTS

A total of 396 amateur and professional singers completed the survey yielding a 40% response rate. Of 396 surveys received, 154 were excluded because the respondent was not a professional singer and/or the survey was incomplete and four were excluded because the respondent was <19 years old (396-158 = 238). Of 238, 199 completed the EASE (included in this analysis sample). The respondents identified their primary singing genre(s) as follows: 29% classical, 22% musical theatre, 45% both classical and musical theatre, and 5% other contemporary styles. Overall mean (SD, range) Rasch converted EASE score was 19.9 units (9.0, 0-50). Mean EASE score was 19.6 for primary classical, 22.7 for primary musical theatre, 18.4 for both classical and musical theatre, and 23.3 for other contemporary styles (P = 0.03). Participants who were older, had more years of singing training, had a college degree or higher in music, studied classical singing in an academic or private setting, and those who received education in vocal health had significantly lower (better) EASE scores (P-values <0.05).

CONCLUSIONS

Professional singers' perception of their current vocal function differed according to their singing genre, age, extent and type of vocal training and vocal health education. Singing teachers, speech-language pathologists, and physicians could use these results to tailor voice education messages to professional singers. This knowledge could help voice care professionals to educate and treat this elite group of voice users to avoid long-term sequelae from suboptimal voice care.

The Measurement and Effects of Vocal Load in Singing Performance. How Much Singing Can a Singer Sing if a Singer Can Sing Songs?

Singing as both an art form and physical activity demands a level of health and skill fitness to meet performance demands. The determination of performance fitness relies on performers' self-evaluations of their vocal capacity for performance, based, amongst other factors, on the current vocal status and ability to manage the associated vocal load. Measurement of load and the impact on the vocal mechanism is complex and influenced by many intrinsic and extrinsic factors. Researchers have attempted to quantify vocal load effects by measuring physical impact stress on the vocal folds, self-reported perceived exertion, and/or clinical evaluation of physiologic, acoustic, or perceptual changes. Most studies have been conducted in laboratory rather than in performance contexts and studies on singers are substantially lacking. Heavy vocal load has been causally associated with the development of voice disorders, although the exact relationship and thresholds for acquiring laryngeal pathology require further elucidation, and little is also known about the development of voice disorders among singers. Further understanding of the short-term and cumulative effect on the vocal folds of performing as a singer and the nature and prevalence of voice problems among singers is crucial to the determination of appropriate prevention and therapeutic management.