Vocal risk mapping in classical singers: an analysis of the self-perception of voice quality, vocal fatigue, and singing voice handicap

Gomes, Diógenes; Moreti, Felipe; Behlau, Mara

doi:10.1590/2317-1782/20242023088en

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Original Article • CoDAS 36 (4) • 2024 • https://doi.org/10.1590/2317-1782/20242023088en copy

Vocal risk mapping in classical singers: an analysis of the self-perception of voice quality, vocal fatigue, and singing voice handicap

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To map the vocal risk in professional classical singers, analyzing their self-assessment of voice and self-perception of singing voice handicap and vocal fatigue.

Methods

The study sample comprised of 52 professional classical choir singers, aged 31 to 72 years. They answered an online questionnaire in Google Forms, addressing their characterization, self-assessment of voice, the Voice Handicap Index-10 (VHI-10), Classical Singing Handicap Index (CSHI), and Vocal Fatigue Index (VFI).

Results

The mean self-assessment of voice was between “Good” and “Very good” (1.2). The mean total VHI-10 score was 1.35, which is below the cutoff. The mean total CSHI score was 10.04. The mean total VFI score was 10.83, near the cutoff value. Classical singers who use their voice to give examples to students in their classes had higher scores in VHI-10 (p = 0.013), VFI voice restriction (p = 0.011), and VFI total score (p = 0.015). Besides, classical singers who already visited a Speech-Language Pathologist for voice problems had higher scores in VFI voice restriction (p = 0.040) and VFI recovery with voice rest (p = 0.019), in addition to correlations between instrument scores.

Conclusion

Professional classical singers did not have voice handicaps. However, their self-perception of vocal fatigue was more present when the singing voice was used, such as giving examples with their own voice in class. Having had voice problems and visited a Speech-Language Pathologist in the past led to a greater perception of vocal recovery with rest.

Keywords:
Voice; Singing; Self-Testing; Surveys and Questionnaires; Fatigue; Speech; Language and Hearing Sciences

Variable and categories	n	%
Sex
Males	28	53.85
Females	24	46.15
Name of the choir where you sing professionally:
Coral Lírico do Theatro Municipal de São Paulo	33	63.46
Coral Paulistano do Theatro Municipal de São Paulo	2	3.85
Coro da Orquestra Sinfônica do Estado de São Paulo	4	7.69
Coro Municipal do Rio de Janeiro	6	11.54
Coro da Ópera de Manaus / Coral Lírico do Amazonas	4	7.69
Coral / Coro Lírico de Minas Gerais	3	5.77
Voice type:
Soprano	13	25.00
Mezzo	6	11.54
Contralto	5	9.62
Tenor	9	17.31
Baritone	12	23.08
Bass	7	13.45
Are you currently taking singing lessons with a singing teacher?
No	32	61.54
Yes	20	38.46
Have you been regularly studying singing for over a year?
No	12	23.08
Yes	40	76.92
How long have you been a professional singer?
5 to 6 years	1	1.92
7 to 8 years	1	1.92
9 to 10 years	1	1.92
> 10 years	49	94.23
How many hours do you use your singing voice in your daily routine?
Up to 1 hour	9	17.31
1 to 2 hours/day	13	25.00
3 to 5 hours/day	26	50.00
6 or + hours/day	4	7.69
Do you use your voice in class to give examples to your students?
Yes	26	50.00
I do not teach	26	50.00
Do you warm your voice up before singing, teaching singing classes, or rehearsing?
No	2	3.85
Yes	50	96.15
Do you cool your voice down after singing, teaching singing classes, or rehearsing?
No	34	65.38
Yes	18	34.62
Do you currently have any vocal complaints or voice problems?
No	52	100.00
Yes	0	0
Do you smoke any cigarettes or drugs?
No	46	88.46
Ex-smoker	4	7.69
Yes	2	3.85
Do you drink alcoholic beverages?
No	35	67.31
Yes	17	32.69
Have you ever visited a Speech-Language Pathologist for voice problems?
No	24	46.15
Yes	28	53.85
Have you ever visited an otorhinolaryngologist for voice problems?
No	13	25.00
Yes	39	75.00
Have you ever had vocal treatment? Speech-Language Pathology exercises?
No	30	57.69
Yes	22	42.31
Singing exercises
No	43	82.69
Yes	9	17.31
Medications
No	31	59.62
Yes	21	40.38
Surgery
No	51	98.08
Yes	1	1.92
Others
No	51	98.08
Yes	1	1.92
Do you have or have you ever had a medical diagnosis of laryngeal neurological or oncological head and neck disease or a history of cervical or laryngeal trauma with anatomical or functional sequelae?
No	51	98.08
Yes	1	1.92
Do you know anything about vocal fatigue and its causes and effects on the voice?
No	3	5.77
Yes	49	94.23
Do you know anything about vocal rest during the day and its benefits?
No	2	3.85
Yes	50	96.15
Do you rest your voice during the day?
No	6	11.54
Up to 1 hour/day	7	13.46
1 to 2 hours/day	19	36.54
3 to 5 hours/day	12	23.08
6 or more hours/day	8	15.38
Do you know anything about vocal health and hygiene and their benefits to the voice?
No	3	5.77
Yes	49	94.23

		CSHI Disability	CSHI Handicap	CSHI Impairment	CSHI Total	VFI Tiredness and voice impairment	VFI Avoidance of voice use	VFI Physical discomfort	VFI Improvement of voice symptoms with rest	VFI Total
VHI-10 Total	r	0.387	0.422	0.356	0.442	0.415	0.218	0.241	-0.051	0.339
VHI-10 Total	p-value	0.005*	0.002*	0.010*	0.001*	0.002*	0.120	0.086	0.721	0.014*
CSHI Disability	r		0.450	0.716	0.868	0.329	0.133	0.289	0.129	0.149
CSHI Disability	p-value		0.001*	0.000*	0.000*	0.017*	0.349	0.038*	0.362	0.293
CSHI Handicap	r			0.539	0.693	0.314	0.366	0.255	0.311	0.076
CSHI Handicap	p-value			0.000*	0.000*	0.023*	0.008*	0.069	0.025*	0.594
CSHI Impairment	r				0.921	0.378	0.142	0.400	0.193	0.127
CSHI Impairment	p-value				0.000*	0.006*	0.315	0.003*	0.170	0.371
CSHI Total	r					0.410	0.240	0.373	0.218	0.160
CSHI Total	p-value					0.003*	0.086	0.007*	0.121	0.258
VFI Tiredness and voice impairment	r						0.511	0.472	0.153	0.606
VFI Tiredness and voice impairment	p-value						0.000*	0.000*	0.280	0.000*
VFI Avoidance of voice use	r							0.353	0.287	0.528
VFI Avoidance of voice use	p-value							0.010*	0.039*	0.000*
VFI Physical discomfort	r								0.236	0.369
VFI Physical discomfort	p-value								0.091	0.007*
VFI Improvement of voice symptoms with rest	r									-0.481
VFI Improvement of voice symptoms with rest	p-value									0.000^* * Significant values (p ≤ 0.05) – Spearman correlation test

Variable	Mean	SD	Maximum	Q₁	Median	Q₃
Vocal self-assessment	1.10	0.75	3.00	1.00	1.00	1.75
VHI-10 Total	1.35	1.77	7.00	0.00	1.00	2.00
CSHI Disability	3.44	3.20	14.00	0.00	3.00	5.75
CSHI Handicap	2.35	2.92	12.00	0.00	1.00	4.00
CSHI Impairment	4.25	4.18	16.00	0.25	3.00	6.00
CSHI Total	10.04	9.19	41.00	3.25	8.00	12.00
VFI Tiredness and voice impairment	2.52	2.75	12.00	0.00	2.00	4.00
VFI Avoidance of voice use	3.42	2.94	10.00	1.00	3.00	6.00
VFI Physical discomfort	0.63	1.07	4.00	0.00	0.00	1.00
VFI Improvement of voice symptoms with rest	7.75	4.21	12.00	4.00	9.00	12.00
VFI Total	10.83	5.85	25.00	8.00	11.00	15.00

Variable	Do you use your voice in class to give examples to your students?	Mean	SD	Minimum	Maximum	Q₁	Median	Q₃	p-value
Vocal self-assessment	Yes	1.08	0.69	0.00	3.00	1.00	1.00	1.00	0.831
Vocal self-assessment	I do not teach	1.12	0.82	0.00	3.00	0.75	1.00	2.00	0.831
VHI-10 Total	Yes	1.88	1.99	0.00	7.00	0.00	1.00	2.25	0.013*
VHI-10 Total	I do not teach	0.81	1.36	0.00	5.00	0.00	0.00	2.00	0.013*
CSHI Disability	Yes	3.73	3.01	0.00	11.00	1.75	3.00	6.25	0.368
CSHI Disability	I do not teach	3.15	3.41	0.00	14.00	0.00	3.00	5.25	0.368
CSHI Handicap	Yes	2.73	2.79	0.00	10.00	1.00	1.00	4.25	0.066
CSHI Handicap	I do not teach	1.96	3.05	0.00	12.00	0.00	0.00	3.25	0.066
CSHI Impairment	Yes	3.85	3.40	0.00	13.00	1.00	3.00	6.00	0.875
CSHI Impairment	I do not teach	4.65	4.87	0.00	16.00	0.00	3.00	7.25	0.875
CSHI Total	Yes	10.31	8.03	1.00	31.00	4.00	8.00	12.25	0.463
CSHI Total	I do not teach	9.77	10.37	0.00	41.00	0.00	8.50	13.25	0.463
VFI Tiredness and voice impairment	Yes	2.88	3.17	0.00	12.00	0.00	2.00	6.00	0.553
VFI Tiredness and voice impairment	I do not teach	2.15	2.27	0.00	7.00	0.00	2.00	3.25	0.553
VFI Avoidance of voice use	Yes	4.42	2.83	0.00	10.00	1.75	5.00	6.25	0.011*
VFI Avoidance of voice use	I do not teach	2.42	2.74	0.00	10.00	0.00	1.50	4.00	0.011*
VFI Physical discomfort	Yes	0.69	1.16	0.00	4.00	0.00	0.00	1.00	0.665
VFI Physical discomfort	I do not teach	0.58	0.99	0.00	3.00	0.00	0.00	1.00	0.665
VFI Improvement of voice symptoms with rest	Yes	7.31	3.86	0.00	12.00	4.00	8.00	12.00	0.344
VFI Improvement of voice symptoms with rest	I do not teach	8.19	4.58	0.00	12.00	3.75	11.00	12.00	0.344
VFI Total	Yes	12.69	6.29	0.00	25.00	9.50	12.50	16.25	0.015^* * Significant values (p ≤ 0.05) – Mann-Whitney test
VFI Total	I do not teach	8.96	4.79	0.00	20.00	5.00	9.00	12.00	0.015^* * Significant values (p ≤ 0.05) – Mann-Whitney test

Variable	Do you cool your voice down?	Mean	SD	Minimum	Maximum	Q₁	Median	Q₃	p-value
Vocal self-assessment	No	1.09	0.75	0.00	3.00	1.00	1.00	2.00	0.983
Vocal self-assessment	Yes	1.11	0.76	0.00	3.00	1.00	1.00	1.25	0.983
VHI-10 Total	No	1.35	2.00	0.00	7.00	0.00	0.00	2.00	0.322
VHI-10 Total	Yes	1.33	1.28	0.00	5.00	0.00	1.00	2.00	0.322
CSHI Disability	No	3.26	3.23	0.00	14.00	0.00	3.00	5.00	0.559
CSHI Disability	Yes	3.78	3.21	0.00	11.00	1.75	3.00	6.25	0.559
CSHI Handicap	No	2.15	2.95	0.00	12.00	0.00	1.00	4.00	0.276
CSHI Handicap	Yes	2.72	2.93	0.00	10.00	0.75	1.50	4.25	0.276
CSHI Impairment	No	4.44	4.54	0.00	16.00	0.00	4.00	6.25	0.808
CSHI Impairment	Yes	3.89	3.50	0.00	13.00	2.00	3.00	5.50	0.808
CSHI Total	No	9.85	9.61	0.00	41.00	2.50	8.00	12.75	0.664
CSHI Total	Yes	10.39	8.58	2.00	31.00	4.00	7.50	12.25	0.664
VFI Tiredness and voice impairment	No	2.38	2.66	0.00	12.00	0.00	2.00	3.00	0.729
VFI Tiredness and voice impairment	Yes	2.78	2.98	0.00	8.00	0.00	1.50	6.00	0.729
VFI Avoidance of voice use	No	2.71	2.68	0.00	10.00	0.00	2.00	5.00	0.016^* * Significant values (p ≤ 0.05) – Mann-Whitney test
VFI Avoidance of voice use	Yes	4.78	3.00	0.00	10.00	1.75	5.50	7.00	0.016^* * Significant values (p ≤ 0.05) – Mann-Whitney test
VFI Physical discomfort	No	0.56	0.99	0.00	4.00	0.00	0.00	1.00	0.562
VFI Physical discomfort	Yes	0.78	1.22	0.00	4.00	0.00	0.00	1.25	0.562
VFI Improvement of voice symptoms with rest	No	7.12	4.37	0.00	12.00	3.75	8.50	12.00	0.122
VFI Improvement of voice symptoms with rest	Yes	8.94	3.72	1.00	12.00	6.75	10.50	12.00	0.122
VFI Total	No	10.53	5.32	0.00	25.00	7.75	11.00	14.25	0.623
VFI Total	Yes	11.39	6.87	0.00	23.00	7.25	10.50	17.00	0.623

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[1] Conflict of interests: nothing to declare.