Healthy voice use is essential in society because of impacts of voice disorders on work, quality of life (QOL) and health costs, and because of the value of singing to public health. 

Professional voice users – teachers, singers, actors, actresses, broadcasters, clergy, salespeople, courtroom attorneys, telemarketers, and health care specialists – constitute about 30% of the working population (Titze et al., 1997). These professionals require a functional voice; however, their intensive voice use exposes them to vocal trauma (Williams, 2003). Many and rapid collisions of the vocal folds constitute an occupational risk (Fritzell, 1996) comparable to the exposure to dangerous chemicals or to sun (Titze, Švec & Popolo, 1996). Occupational safety and health (OS&H) are still lacking in supporting for vocal problems (Vilkman, 2001). Prevalence of voice disorders has continued to increase, augmenting healthcare costs (Benninger, Bryson & Milstein, 2017) with up to 35% of work absence (teachers) (Ahlander, Rydell & Löqvist, 2011).  

There are different groups of professional voice users, according to amount of voice use and vocal demand (Koufman & Isaacson, 1991). These groups can be organized in a, at the top having those who are elite performers, such as singers and actors, and at the bottom professional whose work is not compromised even when sever vocal difficulties exist (see Figure 1). 

Figure 1. Pyramid of voice users, classified according to amount and demand of voice use (adapted from Koufman & Isaacson, 1991)

 Voice problems are perceived as negative not only to work ability of professional voice users, but also to QOL (Behlau, Hogikyan & Gasparini, 2007; Cohen, Dupont & Courey, 2006Verdolini & Ramig, 2001), especially to women (Hunter, Tanner & Smith, 2011). Females have higher prevalence of chronic voice disorders compared to males (Roy et al., 2004). Both gender-related differences in voice (Klatt & Klatt, 1990; Roers, Mürbe & Sundberg, 2009) and endocrine system affect more recurrently the female voice (Lã & Davidson, 2005; Lã et al., 2007; Lã et al., 2009; Lã & Sundberg, 2012). Voice-related quality of life (V-RQOL) is also more affected in females (Behlau, Hogikyan & Gasparini, 2007. If voice conditions are a problem, what can we do?  

To raise awareness of healthy voice use is essential, not only because of the impacts of voice disorders; singing has benefits at both individual and social levels (Kreutz et al., 2004). Group singing can be therapeutic (Clift, 2012), and a public health resource (Stacy, Brittain, & Kerr, 2002). Singing is a common and appreciated creative activity in the support of health care and wellbeing in communities (Bungay, Clift, & Skingley, 2010). Singing promotes: social inclusion and cohesion (Greaves & Farbus, 2006); mental and physical health (Glick, 2011); psychological wellbeing (Clift et al., 2010); cognitive development, (Bilhartz, 1999). No wonder the growing interest in socio-cultural dimensions of singing, and the provision of quality education for healthy and effective voice use. 

Further readings: 

  1. Ahlander, V.L., Rydell, R & Löfqvist, A. (2011). Speaker’s Comfort in Teaching Environments: Voice Problems in Swedish Teaching Staff. Journal of Voice, 25(4): 430 
  2. Behlau, M., Hogikyan, N.D. & Gasparini, G. (2007). Quality of Life and Voice: Study of a Brazilian Population using the Voice-Related Quality of Life Measure. Folia Phoniatrica et Logopedica, 59: 286-296. 
  3. Benninger, M.S., Holy, C.E., Bryson, P.C. & Milstein, C.F. (2017). Prevalence and Occupation of Patients Presenting With Dysphonia in the United States. Journal of Voice, 31(5): 594 
  4. Bilhartz, T.D., Bruhn, R.A. & Olson, J.E. (1999). The Effect of Early Music Training on Child Cognitive Development. Journal of Applied Developmental Psychology, 20(4): 615 – 636. 
  5. Bungay, H., Clift, S. & Skingley, A. (2010). The Silver Song Club Project: A sense of well-being through participatory singing. Journal of Applied Arts & Health, 1(2): 165 – 178. 
  6. Clift, S., Grenville, H., Morrison, I., Hess, B., Kreutz, G. & Stewart, D. 2010). Choral singing and psychological wellbeing: Quantitative and qualitative findings from English choirs in a cross-national survey. Journal of Applied Arts & Health, 1(1): 19 – 34. 
  7. Clift, S. (2012). Creative arts as a public health resource: moving from practice-based research to evidence-based practice. Perspectives Public Health, 132(3): 120 – 127. 
  8. Cohen, S. M., Dupont, W.D. & Courey, M.S. (2006). Quality-of-Life Impact of Non-Neoplastic Voice Disorders: A Meta-Analysis. Annals of Otology, Rhinology & Laryngology, 115(2): 128-134. 
  9. Fritzell, B. (1996). Voice disorders and ocupations. Logopedics Phoniatrics Vocology, 6 (1): 21:7 
  10. Gick M.L. (2011). Singing, health and well-being: A health psychologist’s review. Psychomusicology:Music, Mind & Brain, 21(1-2): 176 – 207. 
  11. Greaves CJ. & Farbus L. 2006. Effects of creative and social activity on the health and well-being of socially isolated older people: outcomes from a multi-method observational study. Journal of Royal Society of Promotion of Health, 126(3): 134-142. 
  12. Hunter, E.J., Tanner, K. & Smith, M.E. (2011). Gender differences affecting vocal health of women in vocally demanding careers. Logopedics Phoniatrics Vocology, 36(3): 128-136. 
  13. Klatt, D.H. & Klatt, L.C. (1990). Analysis, synthesis, and perception of voice quality variations among female and male talkers. Journal of the Acoustical Society of American, 87: 820-857. 
  14. Koufman, J. A., & Isaacson, G. (1991). The spectrum of vocal dysfunction. Otolaryngologic Clinics of North America, 24(5), 985-988.
  15. Kreutz, G., Bongard, S., Rohrmann, S., Hodapp, V. & Grebe, D. (2004). Effects of Choir Singing or Listening on Secretory Immunoglobulin A, Cortisol, and Emotional State. Journal of Behaviour Medicine, 27(6): 623-635. 
  16. Lã F.M.B., Howard, D.M., Ledger, W., Davidson, J.W. & Jones, G. (2009). Oral contraceptive pill containing drospirenone and the professional voice: an electrolaryngographic analysis. Logopaedics Phoniatrics Vocology, 34 (1): 11-19. 
  17. Lã, F.M.B., Ledger, W.L., Davidson, J.W., Howard, D.M. & Jones, G.L. (2007). The Effects of a Third Generation Combined Oral Contraceptive Pill on the Classical Singing Voice. Journal of Voice, 21 (6): 754-761. 
  18. Lã, F. & Davidson, J.W. (2005). Investigating the Relationship between Sexual Hormones and Female Western Classical Singing. Research Studies in Music Education, 24: 75-87.  
  19. Lã, F.M.B. & Sundberg, J. (2012). Pregnancy and the Singing Voice: Reports From a Case Study. Journal of Voice, 26 (4): 431-439. 
  20. Mellor, L. (2013). An investigation of singing, health and well-being as a group process. British Journal of Music  Education, 30(2): 177-205. 
  21. Roers, F., Mürbe, D. & Sundberg, J. (2009). Predicted Singers’ Vocal Lengths and Voice Classification – A Study of X-Ray Morphological Measures. Journal of Voice, 23(4): 408-413. 
  22. Roy, N., Merrill, R.M., Thibeault, S., Gray, S.D. & Smith, E.M. (2004). Journal of Speech, Language and Hearing Research, 47: 542-551. 
  23. Stacy, R., Brittain, K. & Kerr, S. (2002). Singing for health: an exploration of the issues. Health Education, 12(4): 156 – 162. 
  24. Titze, I.R., Lemke, J. & Montequin, D. (1997). Populations in the U.S. Primary Tool of Workforce Who Rely on Voice Trade: A Preliminary Report. Journal of Voice, 11(3): 254 
  25. Titze, I.R., Švec, J.G. & Popolo, P.S. (2003). Vocal Dose Measures: Quantifying Accumulated Vibration Exposure in Vocal Fold Tissues. Journal of Speech, Language and Hearing Research, 46: 919 
  26. Verdolini, K. & Ramig, L.O. (2001). Review: Occupational Risks for Voice Problems. Logopedics Phoniatrics Vocology, 26(1): 37-38. 
  27. Vilkman E. (2001). A survey on the occupational safety and health arrangement for voice and speech professionals in Europe. In Ph. Dejonckere (ed.) Occupational Voice: Care and Cure. The Hague: Kugler Publications. 
  28. Williams, N.R. (2003). Occupational groups at risk of voice disorders: a review of the literature. Occupational Medicine, 53(7): 456 
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