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.

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.

Clinical Practices in Head and Neck Cancer: A Speech-Language Pathologist Practice Pattern Survey.

OBJECTIVE: Clinical practices of speech-language pathologists (SLP) treating head and neck cancer (HNC) patients range widely despite literature trending toward best practices. This survey study was designed to identify current patterns and assess for gaps in clinical implementation of research evidence. METHOD: A web-based survey was distributed to SLPs via listserv and social media outlets. Descriptive statistics and group calculations were completed to identify trends and associations in responses. RESULTS: Of 152 received surveys, the majority of respondents were hospital-based (86%) and had greater than 5 years of experience (65%). There was group consensus for the use of prophylactic exercise programs (95%), recommendations for SLP intervention during HNC treatment (75%), and use of maintenance programs post-treatment (97%). Conversely, no group consensus was observed for use of pre-treatment swallow evaluations, frequency of service provision, and content of therapy sessions. Variation in clinical decision making was noted in use of prophylactic feeding tubes and number of patients taking nothing by mouth during treatment. No associations were found between years of experience and decision-making practices, nor were any associations found between practice setting and clinical decision making. CONCLUSION: Despite the growing body of literature outlining evidence-based treatment practices for HNC patients, clinical practice patterns among SLPs continue to vary widely resulting in inconsistent patient care across practice settings. As compared to prior similar data, increased alignment with best practices was observed relative to early referrals, implementation of prophylactic intervention programs, and intervention with the SLP during the period of HNC treatment.

Prevalence of Vocal Fold Pathologies Among First-Year Singing Students Across Genres.

OBJECTIVES/HYPOTHESIS: The purpose of the study was to compare the prevalence of vocal fold pathologies among first-year singing students from the classical, musical theatre, and contemporary commercial music (CCM) genres. STUDY DESIGN: Prospective cohort study. METHODS: Videostroboscopic examinations were rated by blinded expert raters. Vocal pathology was defined as a vocal fold abnormality on the membranous or cartilaginous portions of the vocal folds or hypomobility. Consensus among three of four raters confirmed presence of pathology. Association between genre of singer and presence of pathology, interrater reliability, and intrarater reliability were calculated. Differences in singing voice handicap, and voice use and vocal hygiene were compared. RESULTS: Fifty-seven participants were included. Seventeen percent of CCM, 40% of musical theatre, and 0% of classical singers were found to have vocal fold pathology. Interrater reliability was 0.522 between all four raters, 0.591 between the two laryngologists, and 0.581 between the two speech-language pathologists, showing a moderate agreement (P < .0001). Intrarater reliability was 1.000 (P < .0001) for the two laryngologists and 0.452 (P = .949) and 0.622 (P = .828) for the two speech-language pathologists. Singing Voice Handicap Index-10 data across genre showed differences between CCM and classical singers. No significant differences were found in voice usage or vocal hygiene. CONCLUSIONS: No classical students were found to have vocal fold pathology, whereas CCM and musical theatre students had significantly higher prevalence of pathologies. Voice use, vocal hygiene, and physiologic phonatory differences among classical, musical theatre, and CCM genres may be risk factors for development of vocal pathology. LEVEL OF EVIDENCE: 2b Laryngoscope, 130: 1996-2002, 2020.

Changing trends of speech outcomes after total laryngectomy in the 21st century: a single-center study.

OBJECTIVES/HYPOTHESIS: To describe the speech rehabilitation outcomes of patients undergoing total laryngectomy (TL) in the 21st century. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary academic center SUBJECTS AND METHODS: Retrospective review of 167 patients who underwent TL from June 2000 to February 2012. Demographics, disease variables, and surgical factors were reviewed. Primary alaryngeal speech modality, speech outcome, and tracheoesophageal puncture (TEP) complication rates were assessed. RESULTS: Overall TEP speech success rate (primary or secondary) was 72%. Overall TEP speech success rate was 76% for those with primary TEP and was 68% for those with secondary TEP. TEP speech success rates at first, second, and beyond second year were 75%, 72%, and 70%, respectively. Success rates for primary TL, salvage TL, primary TL with pharyngeal reconstruction, or salvage TL with pharyngeal reconstruction groups were 71%, 72%, 73%, and 71%, respectively. TEP-related complications occurred in 43% of patients, with no difference in complication rates between primary versus salvage TL or primary versus secondary TEP. For those with complications, TEP success rate was 65%. CONCLUSION: This study showed TEP speech-outcome success rates lower than what has been historically reported. There was no significant difference in TEP speech outcome between primary versus salvage TL or primary versus secondary TEP. Patients with TEP-related complications had TEP speech-outcome success rates comparable to those without any complication. TEP may continue to be a superior option as a mode of speech in patients with TL, including those undergoing salvage TL. LEVEL OF EVIDENCE: 4.

Longitudinal tracheoesophageal puncture size stability.

OBJECTIVE: The purpose of this study is to investigate prosthesis size stability over time and determine which factors influence need for change in size. STUDY DESIGN: Retrospective chart review. SETTING: Teaching hospital. SUBJECTS AND METHODS: Retrospective chart review was performed on all individuals who had previously undergone total laryngectomy and tracheoesophageal puncture and had a minimum of 3 years of consistent and consecutive follow-up data after their prosthesis was initially placed. Data reviewed included demographic variables of age at time of tracheoesophageal puncture, ethnicity, and sex. RESULTS: Fifty patients were identified who met criteria for study inclusion with a mean age of 64.7 years (range, 43-86 years) with 41 (82%) men and 9 (18%) women. Surgical management was equally divided between those who underwent total laryngectomy (n = 25) as primary treatment vs those who had salvage laryngectomy (n = 25) for persistent or recurrent disease. Prosthesis size was stable, with no change in diameter or length, in only 5 (10%) patients and unstable in 45 (90%), as they were changed at least once. The only factor that demonstrated statistical significance was sex (Fisher exact test = 0.035), with women being more likely to have a stable prosthesis size over time. CONCLUSIONS: The results of this study demonstrate that 90% of patients who underwent total laryngectomy and tracheoesophageal puncture required a change in their prosthesis size beyond the first 3 months of expected healing. These results support the need for continual reassessment of the fistula tract when changing the prosthesis to ensure appropriate fit.