A Pilot Study Assessing the Therapeutic Potential of a Vibratory Positive Expiratory Pressure Device (Acapella Choice) in the Treatment of Voice Disorders.

INTRODUCTION: Semioccluded vocal tract exercises (SOVTEs) can involve a single source of vibration (eg, vocal folds in the straw exercise) or a dual source of vibration (eg, vocal folds and water bubbling in tube phonation) in the vocal tract. Oftentimes, this secondary source of vibration causes large oscillations in intraoral pressure and has been likened to a "massage effect." This study assesses the implementation of a positive expiratory pressure device (Acapella Choice) as a possible alternative SOVTE, which presents a secondary source of vibration without the need of a water container. METHODS: Twenty-two normophonic participants underwent acoustic, electroglottographic, and aerodynamic assessment before, during, and after phonation with two different established SOTVEs (silicone tube in water and straw in air) in addition to Acapella Choice. RESULTS: Acapella Choice produced the largest peak-to-peak amplitudes of intraoral pressure oscillation. Straw in air produced the largest static intraoral pressure. Straw in air and Acapella Choice presented significantly larger ranges of static pressures than tube in water phonation. Post-exercise condition showed a statistically larger sound pressure level for Acapella Choice. CONCLUSIONS: Positive expiratory pressure devices, such as Acapella Choice, may be a promising alternative to established SOVTEs as it promotes large oscillatory pressures in the vocal tract without the need for a water container. This exercise also produces larger sound pressure level with no significant changes in glottic contact quotient, indicating improved vocal economy.

Functional Electrical Stimulation for Presbyphonia: A Prospective Randomized Trial.

OBJECTIVES: The aim of this prospective study was to examine the effects of transcutaneous functional electrical stimulation (FES) in a group of elderly women with presbyphonia. STUDY DESIGN: Prospective randomized study. METHODS: Fourteen participants were enrolled prospectively and attributed randomly to two different treatment groups, where one group (n = 7) received 8 weeks of training (5 days a week), whereas the other group (n = 7) received 4 weeks of ineffective stimulation, followed by 4 weeks of effective training. Stimulation protocols were established during baseline examination and confirmed with endoscopy to ensure a glottal reaction. Numerous acoustical, vocal, patient-centered, and respiratory parameters were obtained at several time points. RESULTS: Neither 4 weeks nor 8 weeks of functional electrical transcutaneous stimulation led to changes of vocal, acoustical, or respiratory parameters, apart from patient-centered items (Voice Handicap Index 12, Voice-Related Quality of Life), which improved over time. However, there were no differences between the two arms for both items. CONCLUSIONS: Transcutaneous FES over 4 weeks and 8 weeks did not lead to significantly improved objective voice and acoustical parameters, which could be caused by the fact that the muscles of interest cannot be targeted specifically enough. However, we found a significant improvement of subjective voice perception and voice-related quality of life in both groups. We explain this finding with an observer-expectancy effect secondary to the very time-consuming and elaborate study procedures. LEVEL OF EVIDENCE: 1b Laryngoscope, 130:E662-E666, 2020.

The Impact of Respiratory Exercises on Voice Outcomes: A Systematic Review of the Literature.

INTRODUCTION: The role of respiratory exercises in voice therapy remains unclear as many patients do not need extensive breath support to meet their voice demands. However, since these exercises are commonly used in clinical practice and ubiquitous in voice therapy textbooks, there is a need to determine the evidence for using respiratory exercises to improve vocal function. OBJECTIVE: The goal of the present review is to determine the state of the evidence regarding the effectiveness of respiratory interventions to improve respiratory and voice outcomes. METHODS: A review of the literature was conducted using three electronic databases: Pubmed, Scopus, and CINAHL. A search strategy was developed to highlight two main concepts: (1) voice and (2) respiratory exercises. RESULTS: Out of 650 articles identified through the search, 23 articles met the inclusion criteria, spanning nine types of respiratory exercises: (1) expiratory muscle strength training; (2) inspiratory muscle strength training; (3) incentive spirometry; (4) isocapnic hyperpnea; (5) respiratory effort treatment; (6) abdominal directives; (7) "easy breathing"; (8) stimulation training; and (9) vocalization with abdominal breath support. Respiratory improvements were reported in 12 articles. Nine of 12 articles also reported some voice improvements, although these were limited to subsets of participants. CONCLUSIONS: The results of this review suggest that the evidence to support using respiratory exercises to improve vocal function is specific to a patient's respiratory and vocal needs. That is, current evidence does not support using respiratory exercises for all patients with voice disorders. Emerging evidence also indicates the importance of generalizing the outcomes of respiratory exercises to voice tasks. It is critical that the mechanism of action through which respiratory exercises can impact voice outcomes be thoroughly understood, and it is hoped that future research will help provide more information in this regard.

Vocal Fatigue-Do Young Speech-Language Pathologists Practice What They Preach?

PURPOSE: Speech-Language Pathologists can be categorized as Level II professional voice users who play the roles of voice therapist or vocal coach to treat voice problems. SLPs may be at the risk of experiencing vocal fatigue due to vocal loading and other contributing factors. The present study was undertaken to find the percentage of SLPs reporting vocal fatigue, the probable factors resulting in vocal fatigue, the measures that are taken to avoid/reduce the occurrence of vocal fatigue, its effect on their professional and personal life and the measures taken to tackle it. RESULTS: The results of this study are based on data collected from 142 SLPs and 50 controls using a questionnaire. 71.13% SLPs reported that they experience vocal fatigue. Some of the contributing factors that are mainly reported are long durations of voice use, voice use for recreational purposes, speaking loudly, frequent throat clearing, lack of adequate hydration and working in noisy or air-conditioned environments. The major symptoms reported were dryness in throat, tightness in neck and shoulder, choking sensation, effortful speech and pain in the throat. 59% SLPs reported that vocal fatigue affected their professional life while 44% SLPs reported that it affects their personal life also to varying degrees. Measures taken to avoid/ reduce the occurrence of vocal fatigue included vocal warm up, break in between sessions, and play activities. Only a few SLPs took intervention measures like ENT consultation, voice therapy, and home remedies. CONCLUSION: SLPs are inevitably at high risk of experiencing vocal fatigue which, if left untreated, will lead to organic voice problems. However, many young SLPs who experience vocal fatigue reported vocal abuse, do not follow vocal hygiene program and do not follow evidence-based preventive or intervention practices to treat vocal fatigue.

Investigation of the Effectiveness of a Holistic Vocal Training Program Designed to Preserve Theatre Students' Vocal Health and Increase Their Vocal Performances; A Prospective Research Study.

OBJECTIVE: The main purpose of this study is to investigate the effectiveness of a 12-week holistic vocal training program designed for theatre students. METHODS: The participants included 10 female and 8 male students, who were third- and fourth-year students of a state conservatory theatre department. Participants randomly selected from among those who were between the ages of 18-30 years, had no history of voice disorders, and had no systemic and neurological disorders. The study group (n = 9) was involved in the vocal training program. The control group (n = 9) has not received any training. During the program, 12 sessions of lectures and voice exercises were given to all participants of the study group for a period of 12 weeks. The sessions were planned to last for a duration of 30-45 minutes. Participants' knowledge of vocal health was assessed using a questionnaire that was developed in the present study and a multidimensional voice assessment protocol including acoustic analyses and audio-perceptual evaluation has been applied. RESULTS: Within-group comparisons indicated a significant increase in the study group participants' knowledge of vocal hygiene after training (P = 0.011). Similarly, the study group outperformed the control group in the vocal mechanism knowledge (P = 0.027). Multidimensional Voice Profile findings revealed that vocal qualities of the control group deteriorated, whereas no alterations were found in the study group. Audio-perceptual analysis conducted through the Consensus Auditory-Perceptual Evaluation of Voice did not introduce significant changes in the control group in overall severity and roughness parameters, these values were found significantly improved for the study group. CONCLUSION: It can be concluded that the Holistic Vocal Training Program designed in the present study is effective for preserving theatre students' vocal health and voice quality. It is important for future studies to search the long-term effects.

Prevalence, Characterization, and Impact of Voice Disorders in Fado Singers.

INTRODUCTION: Fado is a genre of urban folk music from Portugal characterized by some particularities. Some indictions in the study point this population of singers to be at higher risk of developing voice disorders. AIM: This study aims to provide estimates of the prevalence of voice disorders in Fado singers, and to characterize the professional practice and the impact of voice disorders on their careers. METHODS: This is a cross sectional study based on a self-administered questionnaire split into six parts and 55 questions. RESULTS: A gender-balanced sample of 111 singers was achieved. Most of them recorded at least once. Winter and spring were found to be the most difficult seasons in which to sing. The overall prevalence of self-reported voice disorders was 39.6%, significantly higher in females. Almost all sought clinical guidance. Vocal fold nodules, functional dysphonia, and vocal fold polyp were the most common diagnoses. Vocal fatigue and hoarseness were the main symptoms reported. Nearly half of the singers had to cancel shows due to voice disorders. CONCLUSION: Fado singers reveal both a relative high prevalence of voice disorders and related concerns, even though some discrepancies were found regarding other apparently similar singer populations. These results lead support the need for further investigation regarding the risk or protective factors influencing voice disorders.

A Pilot Survey of Warm-Up Practices and Perceptions Among Indian Classical Singers.

OBJECTIVE: Studies have highlighted the importance of having an adequate vocal warm-up exercise regime for prevention of vocal fold injury among singers. Indian classical singing has several singing exercises aimed at improving vocal range and voice. Thus, a need was felt to survey these singers for the warm-up practices they follow and their perception about them. STUDY DESIGN: Cross-sectional study design. METHODS: A 20-item questionnaire was used comprising of questions on demographic details, vocal warm-up singing, and nonsinging-based practices, perceptions about importance of vocal warm-up, and perceptions about effects of vocal warm-up on voice. RESULTS AND CONCLUSION: Fifty Indian classical singers were surveyed. Sixty-four percent of them used vocal warm-up on a daily basis, whereas the remaining did it weekly. Among the singing-based vocal warm-ups, a combination of different singing notes and scales were most commonly used. The popular nonsinging-based warm-up exercises were breathing practice, humming, and meditation. Overall, the singers had a positive perception of the importance of vocal warm-up. Notably, 94% agreed to the importance of having a vocal warm-up regularly before singing. The findings of the present study will help in understanding the existing vocal warm-up regime and perception of the singers. It will benefit counseling singers regarding vocal hygiene, voice care, and management.

Exploring stimulation patterns for electrical stimulation of the larynx using surface electrodes.

PURPOSE: Functional electrical stimulation (FES) is considered an upcoming treatment modality for a number of laryngeal diseases. However, sound data are scarce when it comes to surface FES to treat voice disorders. Aim of the present study was to identify and differentiate suitable surface FES patterns to activate internal laryngeal muscles. METHODS: Non-invasive FES was performed in a cohort of 17 elderly woman. Our user-customized electrical stimulation setup allowed us to deliver ten different stimulation patterns (rectangular and sawtooth shaped) with variation of frequency and amplitude. Stimulation outcome, i.e., vocal fold (VF) reaction, was continuously verified by transnasal endoscopy. RESULTS: Responses to FES using ten different stimulation patterns varied inter-individually. None of the stimulation parameter sets could elicit a VF reaction in all participants. CONCLUSION: Based on our findings we conclude that individual fitting is necessary when defining surface stimulation parameters. To overcome limitations of previous studies, devices with freely programmable patterns are required as shown here. Endoscopic control of VF reaction is absolutely essential to ensure effectiveness of the delivered patterns.

Evaluation of the Supraglottic and Subglottic Activities Including Acoustic Assessment of the Opera-Chant Singers.

Opera and chant singers learn to effectively use aerodynamic components by breathing exercises during their education. Aerodynamic components, including subglottic air pressure and airflow, deteriorate in voice disorders. This study aimed to evaluate the changes in aerodynamic parameters and supraglottic structures of men and women with different vocal registers who are in an opera and chant education program. Vocal acoustic characteristics, aerodynamic components, and supraglottic structures were evaluated in 40 opera and chant art branch students. The majority of female students were sopranos, and the male students were baritone or tenor vocalists. The acoustic analyses revealed that the mean fundamental frequency was 152.33 Hz in the males and 218.77 Hz in the females. The estimated mean subglottal pressures were similar in females (14.99 cmH2O) and in males (14.48 cmH2O). Estimated mean airflow rates were also similar in both groups. The supraglottic structure compression analyses revealed partial anterior-posterior compressions in 2 tenors and 2 sopranos, and false vocal fold compression in 2 sopranos. Opera music is sung in high-pitched sounds. Attempts to sing high-pitched notes and frequently using register transitions overstrain the vocal structures. This intense muscular effort eventually traumatizes the vocal structures and causes supraglottic activity.

Effect of Auditory-Perceptual Training With Natural Voice Anchors on Vocal Quality Evaluation.

PURPOSE: To analyze the effects of auditory-perceptual training with anchor stimuli of natural voices on inter-rater agreement during the assessment of vocal quality. STUDY DESIGN: This is a quantitative nature study. METHODS: An auditory-perceptual training site was developed consisting of Programming Interface A, an auditory training activity, and Programming Interface B, a control activity. Each interface had three stages: pre-training/pre-interval evaluation, training/interval, and post-training/post-interval evaluation. Two experienced evaluators classified 381 voices according to the GRBASI scale (G-grade, R-roughness, B-breathiness, A-asthenia, S-strain, I-instability). Voices were selected that received the same evaluation by both evaluators: 57 voices for evaluation and 56 for training were selected, with varying degrees of deviation across parameters. Fifteen inexperienced evaluators were then selected. In the pre-, post-training, pre-, and postinterval stages, evaluators listened to the voices and classified them via the GRBASI scale. In the stage interval evaluators read a text. In the stage training each parameter was trained separately. Evaluators analyzed the degrees of deviation of the GRBASI parameters based on anchor stimuli, and could only advance after correctly classifying the voices. To quantify inter-rater agreement and provide statistical analyses, the AC1 coefficient, confidence intervals, and percentage variation of agreement were employed. RESULTS: Except for the asthenia parameter, decreased agreement was observed in the control condition. Improved agreement was observed with auditory training, but this improvement did not achieve statistical significance. CONCLUSION: Training with natural voice anchors suggest an increased inter-rater agreement during perceptual voice analysis, potentially indicating that new internal references were established.

Effect of Parkinson Disease on Emotion Perception Using the Persian Affective Voices Test.

BACKGROUND AND OBJECTIVES: Emotion perception plays a major role in proper communication with people in different social interactions. Nonverbal affect bursts can be used to evaluate vocal emotion perception. The present study was a preliminary step to establishing the psychometric properties of the Persian version of the Montreal Affective Voices (MAV) test, as well as to investigate the effect of Parkinson disease (PD) on vocal emotion perception. METHODS: The short, emotional sound made by pronouncing the vowel "a" in Persian was recorded by 22 actors and actresses to develop the Persian version of the MAV, the Persian Affective Voices (PAV), for emotions of happiness, sadness, pleasure, pain, anger, disgust, fear, surprise, and neutrality. The results of the recordings of five of the actresses and five of the actors who obtained the highest score were used to generate the test. For convergent validity assessment, the correlation between the PAV and a speech prosody comprehension test was examined using a gender- and age-matched control group. To investigate the effect of the PD on emotion perception, the PAV test was performed on 28 patients with mild PD between ages 50 and 70 years. RESULTS: The PAV showed a high internal consistency (Cronbach's α = 0.80). A significant positive correlation was observed between the PAV and the speech prosody comprehension test. The test-retest reliability also showed the high repeatability of the PAV (intraclass correlation coefficient = 0.815, P ≤ 0.001). A significant difference was observed between the patients with PD and the controls in all subtests. CONCLUSION: The PAV test is a useful psychometric tool for examining vocal emotion perception that can be used in both behavioral and neuroimaging studies.

Vocal Health Practices Among School Teachers: A Study From Chennai, India.

INTRODUCTION: A healthy vocal system is a prerequisite to produce a serviceable voice for any vocal profession. The concept of vocal health (VH) among teachers is worth exploring considering their known risk of developing voice disorders. AIM: To provide socioculture-specific information on VH practices and nature of voice problems in teachers. METHOD: A VH questionnaire was developed to elicit opinions toward one's own voice health and factors that indicated and contributed to impaired/poor VH from 384 school teachers. RESULTS AND DISCUSSION: 'Flexible voice' (23%), 'enduring voice' (22%), and 'good voice' (22%) were descriptions to indicate good VH by teachers. 'Vocal fatigue' (13%), 'dry throat' (9.4%), 'throat irritation' (4.7%), and 'pain while swallowing/speaking' (3.1%) were frequently reported throat sensations to indicate poor VH. For 30.2% of the teachers, voice mattered for professional needs. However, most of them managed to cope with voice problems through several home remedies and 'intentional/self-imposed neglect' despite their vocal difficulties. Sociocultural factors influencing these findings and scope to escalate voice problems in teachers as a public health issue are discussed. CONCLUSION AND IMPLICATION: Insight and perception of VH based on self-reports and information on voice practices among teachers pertinent to this geographical location provide scope to develop models for counseling and preventive treatment for voice problems.

Office-Based Procedures for the Diagnosis and Treatment of Laryngeal Pathology.

INTRODUCTION: Since the development of distal chip endoscopes with a working channel, diagnostic and therapeutic possibilities in the outpatient clinic in the management of laryngeal pathology have increased. Which of these office-based procedures are currently available, and their clinical indications and possible advantages, remains unclear. MATERIAL AND METHODS: Review of literature on office-based procedures in laryngology and head and neck oncology. RESULTS: Flexible endoscopic biopsy (FEB), vocal cord injection, and laser surgery are well-established office-based procedures that can be performed under topical anesthesia. These procedures demonstrate good patient tolerability and multiple advantages. CONCLUSION: Office-based procedures under topical anesthesia are currently an established method in the management of laryngeal pathology. These procedures offer medical and economic advantages compared with operating room-performed procedures. Furthermore, office-based procedures enhance the speed and timing of the diagnostic and therapeutic process.

Acoustic and Perceived Measurements Certifying Tango as Voice Treatment Method.

Voice disorders are affecting everyday life in many levels, and their prevalence has been studied extensively in certain and general populations. Notably, several factors have a cohesive influence on voice disorders and voice characteristics. Several studies report that health and environmental and psychological etiologies can serve as risk factors for voice disorders. Many diagnostic protocols, in the literature, evaluate voice and its parameters leading to direct or indirect treatment intervention. This study was designed to examine the effect of tango on adult acoustic voice parameters. Fifty-two adults (26 male and 26 female) were recruited and divided into four subgroups (male dancers, female dancers, male nondancers, and female nondancers). The participants were asked to answer two questionnaires (Voice Handicap Index and Voice Evaluation Form), and their voices were recorded before and after the tango dance session. Moreover, water consumption was investigated. The study's results indicated that the voices' acoustic characteristics were different between tango dancers and the control group. The beneficial results are far from prominent as they prove that tango dance can serve stand-alone as voice therapy without the need for hydration. Also, more research is imperative to be conducted on a longitudinal basis to obtain a more accurate result on the required time for the proposed therapy.

A Vocal Health Survey Among Amateur and Professional Voice Users.

An international survey was conducted to provide insights into current practices related to vocal health among amateur and professional voice users. Vocalists of various genres completed an online survey related to their practice in seeking medical care for vocal health concerns, and their preferences for the type of medical help they seek. Specific vocal symptoms or conditions which the subjects feel would warrant evaluation was also queried, as well as their preference for voice use and management should laryngeal pathology be diagnosed during a medical examination. Participants were knowledgeable in both traditional and alternative medical approaches but showed a preference for those options most readily available, as opposed to those best suited for a vocal issue. Ideally, a combination of traditional and alternative management would appear to be the best long-term strategy for professional and amateur voice users.

Effects of transcutaneous electrical stimulation on vocal folds adduction.

According to most previous studies, inducing movements in internal laryngeal muscles by transcutaneous electrical stimulation (TES) was impossible. However, the movements have been reported after using needle electrodes inserted into the internal superior laryngeal nerve (ISLN). Herein, we aimed to apply an innovative TES protocol to cause movements in vocal folds. A short duration and high frequency electrical current was applied by two surface electrodes just above the entrance of ISLN to larynx. The subjects were 32 normal participants (mean age = 23.87; SD = 3.43). During TES application, the vocal folds' movements were examined by flexible videonasolaryngoscopy. Statistical paired t test was used to analyze the differences of vocal folds opening angle, in degrees, during rest and TES periods. Furthermore, the movements were judged by seven experienced speech pathologists via a 9-point rate scale from -1 (any abduction) to 8 (complete adduction). The mean vocal folds adduction increased by 35.68° (t = 9.35, p > 0.001) due to TES application. The mean qualitative scores assigned by raters to each subject were between 6 and 7 points, which indicate an acceptable adduction in vocal folds through TES. Unlike previous studies, the applied TES protocol in this research induced significant vocal fold movements. This might be attributed to our different stimulation parameters, which were designed to penetrate deeply and stimulate ISLN specifically. It is worth noting that we introduced a novel TES protocol, which should be confirmed and then examined as a complementary therapy for neurologic voice disorders in future studies.

The effect of visual feedback and training in auditory-perceptual judgment of voice quality.

The aim of the present investigation was to evaluate the effect of visual feedback on rating voice quality severity level and the reliability of voice quality judgment by inexperienced listeners. For this purpose two training programs were created, each lasting 2 hours. In total 37 undergraduate speech-language therapy students participated in the study and were divided into a visual plus auditory-perceptual feedback group (V + AF), an auditory-perceptual feedback group (AF), and a control group with no feedback (NF). All listeners completed two rating sessions judging overall severity labeled as grade (G), roughness (R), and breathiness (B). The judged voice samples contained the concatenation of continuous speech and sustained phonation. No significant rater reliability changes were found in the pre- and posttest between the three groups in every GRB-parameter (all p > 0.05). There was a training effect seen in the significant improvement of rater reliability for roughness within the NF and AF groups (all p < 0.05), and for breathiness within the V + AF group (p < 0.01). The rating of the severity level of roughness changed significantly after the training in the AF and V + AF groups (p < 0.01), and the breathiness severity level changed significantly after the training in the V + AF group (p < 0.01). The training of V + AF and AF may only minimally influence the reliability in the judgment of voice quality but showed significant influence on rating the severity level of GRB parameters. Therefore, the use of both visual and auditory anchors while rating as well as longer training sessions may be required to draw a firm conclusion.

Effects of Radioactive Iodine Ablation Therapy on Voice Quality.

OBJECTIVE: The goal of this study was to evaluate the effects of radioactive iodine ablation therapy on voice quality of patients diagnosed with well-differentiated thyroid carcinoma. METHODS: We enrolled 36 patients who underwent total or subtotal thyroidectomy due to well-differentiated thyroid carcinoma. Voice recordings from patients were analyzed for acoustic and aerodynamic voice. The Voice Handicap Index-10 was used for subjective analysis. The control group consisted of 36 healthy participants. Results taken before and after therapy were compared statistically. RESULTS: There were no differences in the results taken before and after therapy for the radioactive iodine ablation group. The Voice Handicap Index-10 results did not differ between groups before and after therapy. CONCLUSION: Radioactive iodine ablation therapy has no effect on voice quality objectively or subjectively.

Prevalence and Risk Factors of Voice Problems Among Primary School Teachers in India.

OBJECTIVES: Teachers are more prone to develop voice problems (VPs) when compared with other professional voice users. The aim of present study was to investigate the prevalence and risk factors of VPs among primary school teachers in India. STUDY DESIGN: Epidemiological cross-sectional survey. METHODS: Self-reporting questionnaire data were collected from 1082 teachers. RESULTS: Out of 1082 teachers who participated in the present study, 188 teachers reported VPs that account for a prevalence rate of 17.4%. Tired voice after long hours of talking was the most frequently reported symptom, followed by sore/dry throat, strain in voice, neck muscle tension, and difficulty in projecting voice. The adjusted odds ratio values showed number of years of teaching, high background noise levels in the classroom, experiencing psychological stress while teaching classes, improper breath management (holding breath while speaking), poor focus of the tone (clenching jaw/teeth while speaking), upper respiratory tract infection, thyroid problems, and acid reflux as significant risk factors for the development of VPs in the current cohort of teachers. CONCLUSIONS: Current results suggest that teachers develop VPs due to multiple risk factors. These factors may be either biological, psychomotor, or environment-related factors. A holistic approach (which could include educating teachers about voice care during their training, and if they develop VP during their career, then managing the VP by taking into consideration different risk factors) addressing all these factors needs to be adopted to prevent VPs in primary school teachers.

Evaluation of Singing Vocal Health in Yakshagana Singers.

INTRODUCTION: Yakshagana, a popular traditional folk art from Karnataka, India, includes singing and dancing. Yakshagana singer or Bhagavata plays an important role in singing and conducting the performance. The present study aims to assess the singing vocal health using Singing Voice Handicap Index-10 (SVHI-10) in these singers and to compare between those who report voice problem and those who do not. METHOD: A cross-sectional study was carried out on 26 Bhagavata using demographic questionnaire and SVHI-10 in the Kannada language. Descriptive statistics was used to summarize the data. Independent sample t test was used to compare the responses for demographic variables between the two groups of singers with and without voice problems. The difference in scores of SVHI-10 between the two groups was analyzed using Pearson's chi-square test. RESULTS: Of the Bhagavata, 38% reported to have experienced voice problems, which affected their singing, with higher total SVHI-10 score (31.2 ± 5.7) compared with those who did not report any problems (16.81 ± 9.56). A statistically significant difference between the groups was noted in the emotional domain and total scores. CONCLUSION: The present study provides preliminary information on the voice handicap reported by Bhagavata. The singers reporting voice problems scored higher on SVHI-10. A healthy singing voice is essential for Yakshagana singers, and voice problems can have a significant impact on their performance and livelihood. Hence, results of the present study indicate the need to understand these singers' voice problems and their impact more comprehensively, and educate them about voice care.