Research Article|Articles in Press

Risk of Dysphonia in Theater Actors: Proposal for a Screening Protocol



      To propose a Dysphonia Risk Screening Protocol for Actors (DRSP-A), test its usability in conjunction with the General Dysphonia Risk Screening Protocol (G-DRSP), determine the cut-off point for a high risk of dysphonia in actors, and compare the risk of dysphonia between actors with and without voice disorders.


      Observational cross-sectional study with 77 professional actors or students. The questionnaires were applied individually and the total scores were summed to calculate the final score of the Dysphonia Risk Screening (DRS-Final). The validity of the questionnaire was verified from the area under the Receiver Operating Characteristic (ROC) curve, and cut-offs were obtained based on diagnostic criteria for screening procedures. Voice recordings were collected for auditory-perceptual analysis and subsequent division into groups with and without vocal alteration.


      The sample showed a high risk of dysphonia. Higher scores in the G-DRSP and in the DRS-Final were found in the group that presented vocal alteration. The cut-off points established for the DRSP-A and DRS-Final were 0.623 and 0.789, respectively, with higher degrees of sensitivity than specificity. Thus, above these values, the risk of dysphonia is greater.


      A cut-off value was calculated for the DRSP-A. This instrument was proven to be viable and applicable. The group with vocal alteration had a higher score in the G-DRSP and DRS-Final, but there was no difference in the DRSP-A.

      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


        • Bele I.V.
        Reliability in perceptual analysis of voice quality.
        J Voice. 2005; 19: 555-573
        • Guzman M.
        • Ortega A.
        • Olavarria C.
        • et al.
        Comparison of supraglottic activity and spectral slope between theater actors and vocally untrained subjects.
        J Voice. 2016; 30: 767.e1-767.e8
        • Berry M.
        • Brown S.
        Acting in action: prosodic analysis of character representation during acting.
        J Exp Psychol Gen. 2019; 148: 1407-1425
        • Rangarathnam B.
        • Paramby T.
        • McCullough G.H.
        “Prologues to a bad voice”: effect of vocal hygiene knowledge and training on voice quality following stage performance.
        J Voice. 2018; 32: 300-306
        • D’haeseleer E.
        • Meerschman I.
        • Claeys S.
        • Leyns C.
        • Daelman J.
        • Van Lierde K.
        Vocal quality in theater actors.
        J Voice. 2017; 31: 510.e7-510.e14
        • Duarte J.M.T.
        • de Souza G.V.S.
        • Simões-Zenari M.
        • Nemr K.
        The actor’s voice: vocal performance assessment by different professionals.
        J Voice. 2020; 36: 440.e1-440.e9
        • Warhurst S.
        • Madill C.
        • McCabe P.
        • Ternström S.
        • Yiu E.
        • Hear R.
        Perceptual and acoustic analyses of good voice quality in male radio performers.
        J Voice. 2017; 31: 259.e1-259.e12
        • Sezin R.K.
        • Özcebe E.
        • Aydinli F.E.
        • Köse A.
        • Günaydin R.O.
        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.
        J Voice. 2020; 34: 302.e21-302.e28
        • Ferreira L.P.
        • Nakamura H.Y.
        • Zampieri E.
        • Constantini A.C.
        Work-related voice disorder: proposal of an individual notification record.
        Distúrb Comun. 2018; 30: 170-178
        • Nemr K.
        • Simões-Zenari M.
        • Duarte J.M.T.
        • Lobrigate K.E.
        • Bagatini F.A.
        Dysphonia risk screening protocol.
        Clinics. 2016; 71: 114-127
        • Silva B.G.
        • Chammas T.V.
        • Simões-Zenari M.
        • Moreira R.R.
        • Samelli A.G.
        • Nemr K.
        Analysis of possible factors of vocal interference during the teaching activity.
        Revis Saúde Públ. 2017; 51: 1-10
        • Batista G.K.S.
        • Simões-Zenari M.
        • Nemr K.
        Cut-off point for high dysphonia risk in children based on the Child Dysphonia Risk Screening Protocol: preliminary findings.
        Clinics. 2020; 75e1682
        • Paulino L.C.
        • Simões-zenari M.
        • Nemr K.
        Dysphonia risk screening protocol for musical theatre actors: a preliminary study.
        CoDAS. 2021; 33: 1-8
        • Nemr K.
        • Cota A.
        • Tsuji D.
        • Simões-Senari M.
        Voice deviation, dysphonia risk screening and quality of live in individuals with various laryngeal diagnoses.
        Clinics. 2018; 73e174
        • Ferreira L.P.
        • Souza G.Z. de
        • Santos J.
        • Ferraz P.R.R.
        • Martz M.L.
        Actor’s voice: association between vocal symptoms and life habits.
        Audiol Commun Res. 2019; 24: 1-8
        • Cohen J.
        A power primer.
        Psychol Bull. 1992; 112: 155-159
        • Cruz M.R.S.dos
        • Yamasaki R.
        • Pacheco C.
        • de Borrego M.C.M.
        • Behlau M.
        Drama students with and without vocal complaint: vocal health and hygiene data, symptoms and voice handicap.
        CoDAS. 2019; 31: 1-7
        • Prebil N.
        • Boltezar I.H.
        • Bahar M.S.
        Risk factors for voice problems in professional actors and singers.
        Zdr Varst. 2020; 59: 92-98
        • Searl J.
        • Dargin T.
        • Bailey E.
        Voice and lifestyle behaviors of student actors: impact of history gathering method on self-reported data.
        J Voice. 2021; 35: 233-246
        • Goulart B.N.G.
        • Vilanova J.R.
        Professional theatre actors: environmental and socio-occupational use of voice.
        J Soc Bras Fonoaudiol. 2011; 23: 271-276
        • Vilanova J.R.
        • Marques J.M.
        • Ribeiro V.V.
        • de Oliveira A.G.
        • Teles L.
        • Silverio K.C.A.
        Actor and drama students: voice related to practice.
        Rev CEFAC. 2016; 18: 897-907
        • Martinez E.Z.
        • Louzada-Neto F.
        • Pereira B.B.
        A curva ROC para testes diagnósticos.
        Cad Saude Colet. 2003; 11: 7-31
        • Lerner M.Z.
        • Paskhover B.
        • Acton L.
        • Young N.
        Voice disorders in actors.
        J Voice. 2013; 2370508
        • Percorari A.
        • Yamasaki R.
        • Badaro F.
        • Borrego M.C.
        • Behlau M.
        Perceived vocal complaint and self-assessment of the vocal problem impact in professional theater actors.
        Audiol Commun Res. 2022; 27e2463