Research Article| Volume 37, ISSUE 2, P294.e15-294.e20, March 2023

Download started.


Independence of Vocal Load From Vocal Pathology Across Singing Genres

Published:January 23, 2021DOI:



      To investigate the extent to which vocal load is associated with previous diagnosis of a vocal pathology among four major genres of singers (primarily classical, primarily musical theatre (MT), classical and MT combined, and contemporary commercial music only).

      Study design

      Cross sectional survey.


      An anonymous online survey was sent out to about 1000 professional singers through convenience sampling to touring companies, opera companies, MT companies, agents, directors and musical directors. Social media and email were used to solicit participation in the study. We utilized means and standard deviations for continuous characteristics and frequencies and percentages for categorical characteristics and calculated P values to assess whether differences were statistically significant.


      A total of 396 professional singers completed the survey, yielding a 40% response rate. Nonprofessional singers, incomplete surveys, and respondents <18 years old were excluded, resulting in a total of 238 responses. Among the 238 participants, 32% were performing in the classical style primarily, 33% in the MTstyle primarily, 15% in both classical and MT, and 20% in other contemporary styles only. Mean age was highest among CV + MT and lowest among primarily MT. Combined classical/MT singers were most likely to have a career outside of vocal performance and continue to work in that career followed by other contemporary styles, classical and MT (P = 0.02). Participants in the combined classical/MT group were most likely to have a reported history of vocal pathology followed by classical, other contemporary styles and MT (not statistically significant). However, participants in the contemporary styles were most likely to have a history of more than one type of vocal pathology. Mean vocal load was highest for the MT group. Other nonsinging factors proved significant such as allergy, hydration and acid reflux. Symptoms of allergies were found to be significant across singing genres. A possible reverse causality association was identified in regards to water intake. Participants with acid reflux were three times more likely to have ever reported vocal pathology.


      Vocal load was not significantly associated with vocal pathology across singing genres; however other nonsinging factors such as allergy, reflux and water intake were significantly associated with vocal pathology.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Alves M
        • Krüger E
        • Pillay B
        • et al.
        The effect of hydration on voice quality in adults: a systematic review.
        J Voice. 2019; 33: 125.e13-125.e28
        • Ohlsson A-C
        • Drevsäter A
        • Brynnel M
        • et al.
        Allergic rhinitis and voice change.
        Logop Phoniatr Vocology. 2016; 41: 143-148
        • Lechien JR
        • Saussez S
        • Nacci A
        • et al.
        Association between laryngopharyngeal reflux and benign vocal folds lesions: a systematic review.
        Laryngoscope. 2019; (lary.27932)
        • Kwok M
        • Eslick GD
        The impact of vocal and laryngeal pathologies among professional singers: a meta-analysis.
        J Voice. 2019; 33: 58-65
        • Phyland DJ
        • Thibeault SL
        • Benninger MS
        • et al.
        Perspectives on the impact on vocal function of heavy vocal load among working professional music theater performers.
        J Voice. 2013; 27: 390.e31-390.e39
        • Phyland DJ
        • Oates J
        • Greenwood KM
        Self-reported voice problems among three groups of professional singers.
        J Voice. 1999; 13: 602-611
        • Gaskill C
        • Cowgill J
        • Many S
        Comparing the vocal dose of university students from vocal performance, music education, and music theater.
        J Sing. 2013; 70: 11-19
        • Bartlett I
        • Wilson PH
        Working 9–5: causal relationships between singers’ “Day Jobs” and their performance work, with implications for vocal health.
        J Voice. 2017; 31: 243.e27-243.e34
        • Myint C
        • Moore JE
        • Hu A
        • et al.
        A comparison of initial and subsequent follow-up strobovideolaryngoscopic examinations in singers.
        J Voice. 2016; 30: 472-477
        • Sataloff RT
        • Hawkshaw MJ
        • Johnson JL
        • et al.
        Prevalence of abnormal laryngeal findings in healthy singing teachers.
        J Voice. 2012; 26 ([doi]): 577-583
        • Lundy DS
        • Casiano RR
        • Sullivan PA
        • et al.
        Incidence of abnormal laryngeal findings in asymptomatic singing students.
        Otolaryngol Neck Surg. 1999; 121: 69-77
        • Lloyd AT
        • Gerhard J
        • Baker P
        • et al.
        Prevalence of vocal fold pathologies among first-year singing students across genres.
        Laryngoscope. 2020; 130: 1996-2002
        • D'haeseleer E
        • Claeys S
        • Meerschman I
        • et al.
        Vocal characteristics and laryngoscopic findings in future musical theater performers.
        J Voice. 2017; 31: 462-469
        • Pestana PM
        • Vaz-Freitas S
        • Manso MC
        Prevalence of voice disorders in singers: Systematic review and meta-analysis.
        J Voice. 2017; 31: 722-727
        • Gehling D
        • Sridharan S
        • Fritz M
        • et al.
        Backstage at broadway: a demographic study.
        J Voice. 2014; 28: 311-315
        • Lechien JR
        • Saussez S
        • Nacci A
        • et al.
        Association between laryngopharyngeal reflux and benign vocal folds lesions: a systematic review.
        Laryngoscope. 2019; 129: E329-E341