Diagnosis and Treatment for the Professional Singer Experts use the term “professional voice users” to denote the segment of the population for whom the voice is used as a primary tool of their occupation. In the United States, this term applies to a staggering 25–35% of the national workforce (Titze, Lemke, & Montequin, 1997; Wingate, Brown, Shrivastav, ... Article
Free
Article  |   March 2013
Diagnosis and Treatment for the Professional Singer
Author Affiliations & Notes
  • Brian E. Petty
    Department of Otolaryngology—Head & Neck Surgery, Emory Voice Center, Emory University, School of Medicine, Atlanta, GA
  • Disclosure: Brian E. Petty has no financial or nonfinancial relationships related to the content of this article.
    Disclosure: Brian E. Petty has no financial or nonfinancial relationships related to the content of this article.×
  • Author's note: Portions of this article were published previously in chapter format in the text Clinical Voice Disorders, 3rd Edition, Arnold E. Aronson and Diane Bless, Eds. (Thieme, 2009)
    Author's note: Portions of this article were published previously in chapter format in the text Clinical Voice Disorders, 3rd Edition, Arnold E. Aronson and Diane Bless, Eds. (Thieme, 2009)×
  • © 2013 American Speech-Language-Hearing Association
Article Information
Speech, Voice & Prosodic Disorders / Voice Disorders / Articles
Article   |   March 2013
Diagnosis and Treatment for the Professional Singer
SIG 3 Perspectives on Voice and Voice Disorders, March 2013, Vol. 23, 15-21. doi:10.1044/vvd23.1.15
SIG 3 Perspectives on Voice and Voice Disorders, March 2013, Vol. 23, 15-21. doi:10.1044/vvd23.1.15

Experts use the term “professional voice users” to denote the segment of the population for whom the voice is used as a primary tool of their occupation. In the United States, this term applies to a staggering 25–35% of the national workforce (Titze, Lemke, & Montequin, 1997; Wingate, Brown, Shrivastav, Davenport, & Sapienza, 2007). Professional singers are a highly visible and specialized cohort within the population of professional voice users and can present an unusual but not insurmountable challenge for physicians and speech-language pathologists charged with their voice care.

Singers place unique demands on their vocal mechanisms in terms of frequency range, amplitude control, acoustic variation, and overall vocal stamina. The risk of injury associated with these demands varies in terms of musical styles and pedagogic traditions, and issues such as general health status, environmental factors, and other influences may affect these risks (Koufman, Radomski, Joharji, Russell, & Pillsbury, 1996). Singers may be significantly impaired by subtle laryngeal changes that might be considered to be within the normal range of variability in the general population. Conversely, the well-trained singer also will possess a high level of neuromuscular laryngeal control that may lessen (or even eliminate) audible symptoms of some laryngeal pathologies (Elias, Sataloff, Rosen, Heuer, & Spiegel, 1997; Lundy, Casiano, Sullivan, Roy, Xue, & Evans, 1999). Therefore, it is imperative that singers seek out medical care that is experienced, multidisciplinary, and sensitive to their functional vocal requirements. Caregivers also must be cognizant of the emotional, physical, financial, and professional sequelae that may arise as a result of vocal impairment (Sataloff, 2005).
Gathering a Comprehensive Case History
Other singers and colleagues often are the first to notice when a singer begins to show signs of vocal difficulty, which can result in a flood of well-meaning suggestions and suggested strategies. Unfortunately, researchers have proven that many remedies considered traditional among professional singers either are ineffective (Roy, Tanner, Gray, Blomgren, & Fisher, 2003) or have adverse effects. If the larynx were like a violin—something the musician could see, touch, and repair—or if the traditional methods of singing instruction emphasized a comprehensive understanding of laryngeal anatomy and physiology, there might not be as much mythology and lore associated with how to take care of it. It is, therefore, important to take a thorough case history, including a detailed description of the remedies that the patient has tried prior to their appointment. The clinician also should discuss thoroughly topics such as medication side effects, GERD symptoms, and psychosocial stressors.
Subtlety of Symptoms
Professional singers often can present to the clinic reporting symptoms that are not initially audible in connected speech tasks. Although singers may express these concerns in disparate ways, most can be categorized as having association with vocal fold closure, pliability, and/or symmetry. The symptoms associated with these areas include difficulty with vocal projection (including vocal fatigue), increased vocal effort during quiet singing, changes to the patient's pitch range, difficulty sustaining longer musical phrases, and/or altered perceptual vocal quality (Dailey, 2005). For the classical or operatic singer, instability in the passaggio, the transition between the modal or “chest” voice and the upper range or “head” voice, can result in pitch breaks, quality disruption, and/or decreased ability to project the voice in that range. The production and manipulation of passaggio is one of the more challenging functional goals faced by the singer during formal singing training. The result of the combination of optimal physiologic function and solid vocal technique is an even, consistent perceptual vocal quality throughout the singer's range, without audible transition from chest to head registers. Difficulty negotiating the passaggio often is one of the first symptoms reported by singers during the onset of early dysphonia.
Voice Use Patterns Not Related to Performance
As with all case history collection, we begin with questions regarding the time and nature of the onset, detailed characterization of symptomatic progression, and inquiries regarding what makes symptoms better or worse. However, it is important to obtain more specific data to understand fully the nature, etiology, and effect of the dysphonia. One of the first issues to address would be the patient's overall voice use behaviors during singing engagements as well as nonmusical activities. Many voice problems in singers are the result of nonmusical vocal behaviors (sometimes related to supplemental employment, for example), or tissue changes related to other medical issues. Many professional singers also are singing teachers themselves, placing yet more demands on the laryngeal mechanism. The clinician should ask multiple open-ended questions regarding teaching environment, scheduling, and ergonomics to provide insight into the patient's overall voice use profile and to illuminate significant etiologic factors.
Voice Study and Dysphonia History
A clear understanding of the nature and amount of singing training in a patient's history is an important component of a comprehensive case history. If the patient has studied singing, the clinician should prompt him or her to report how long their study lasted, when it occurred, and who he or she studied with. For instance, a patient who studied singing for 2 months with their church choir conductor 10 years ago will have a much different understanding of their instrument than the patient who underwent formal singing training for 6 years with an experienced teacher at a prominent conservatory with cessation of training a 1 or 2 years ago. Additionally, the patient should identify whether or not his or her voice study was effective in facilitating a solid singing technique, according to his or her own perception. It is important for the clinician to note that the identification of this distinction certainly should not imply that formal training is necessary for one to be a successful and healthy professional singer, nor should it serve as evidence of the previous teacher's skill. Gathering this information simply will assess the patient's confidence level in his or her own technical abilities and should assist the healthcare provider in planning future intervention.
If the patient is actively studying voice at the time of the evaluation, and if the patient is comfortable providing the information, it is important to obtain the name of their singing teacher and vocal coach. Traditionally, the vocal coach often is an experienced pianist who assists the singer in language/diction, acting/character development, and other forms of performance practice, whereas the singing teacher's role is to facilitate understanding and development of singing technique, with special consideration given to dynamic range, artistic quality, and vocal endurance. Effectively collaborating with the singing teacher and vocal coach ensures that the clinician will present information to the patient that is consistent, helps facilitate carryover of therapeutic techniques, ensures that the approach to therapy and singing teaching are using complementary methods, and establishes a mutually beneficial, interdisciplinary relationship between the professions. The American Speech-Language-Hearing Association, in conjunction with the National Association of Teachers of Singing and the Voice and Speech Trainers Association, have created a position statement codifying the important roles of these skilled professionals in the process of voice habilitation that the clinician should read carefully before beginning the collaborative process (Sandage, 2005).
Singing Style
Certain vocal styles are associated with higher amounts of muscle tension than others, resulting in increased incidence of dysphonia. Choral music, art song, and opera have been linked to lower amounts of muscle tension than jazz/pop, blues, bluegrass/country/western, and rock/gospel (Koufman et al., 1996). It is important to note that many singers perform in more than one style, switching from opera to choral music to jazz depending on their own personal interests, the type of venue, and the needs of their employer. Even within those styles that are associated with low amounts of muscle tension, singers may experience challenges when transitioning between styles. For example, an opera singer may find it difficult to sing in choirs, reporting that he or she feels a sensation of “tightness” or “constraint,” or may perceive respiratory support changes as a result of the singer's attempt to “blend in” with the other voices and not “stick out.” Another singer who performs in the bluegrass or gospel traditions may report that his or her professional culture encourages performers to sing with hyperfunctional technique. They may report that “if I’m not hoarse at the end of the performance, then I wasn’t really trying.” For both of these singers, it is important to approach therapeutic intervention with the understanding that experts will provide treatment within the context of the musical style in which the singer is expected to perform. Even within styles that are considered somewhat hazardous from a vocal misuse standpoint (rock, country/western, etc.), there still is a behavioral margin of improvement that can decrease vocal fatigue and increase perceptual vocal quality. By carefully applying techniques learned in behavioral voice therapy, in collaboration with the singing teacher (if applicable), the clinician can facilitate improved performance outcomes and patient comfort while still respecting the various stylistic singing traditions.
Performance Practices: The Nonclassical Singer
The demands placed on the professional singer depend upon the style of music he or she sings and the type of schedule he or she maintains. Nonclassical singers—such as those who sing gospel, folk, rock, or country/western—should describe the length of their sets (groups of songs), the number and type of whom they usually perform with, the environments they normally perform in, and what kind of amplification they use. They also should describe in detail what they usually do between sets; if the singer has a quiet dressing room to relax between sets, it stands to reason that he or she likely will have fewer symptoms related to vocal overuse at the end of the performance. If the patient sings with a band, he or she often will benefit from simple adjustments to the monitors at the foot of the stage that provide feedback to the singer and band members. These singers also may benefit from in-the-ear monitors, under the supervision of an audiologist who has experience working with musicians. If the performance venue is a smoky bar or club, the singer often will benefit from small electric fans on the floor of the stage next to the monitors to create airflow away from the singer.
Performance Practices: The Classical Singer
The performance demands of the classical singer are somewhat different from singers of other musical styles. The classical singer is amplified much less frequently, which requires more attention to careful manipulation of resonance and formant shaping (Sundberg, 2001). Opera houses and concert halls may not present the obvious challenges found in smoky bars and raucous clubs, but they have their own characteristics and pitfalls that are unique to each location. If the acoustic properties of the venue are suboptimal, it may result in “over-singing,” or hyperfunctional vocal projection due to decreased auditory feedback.
The demands of the particular performance also will affect the singer's vocal demands. The size of the hall and the size of the orchestra with which the classical singer is performing will affect the singer's perception of vocal demand. If the singer is performing an operatic role, it is important to know whether or not he or she has performed the role previously or if it is new for him or her, as well as how much time the singer will have to spend on stage for the role. Some operatic roles allow for occasional vocal recovery time during costume changes, whereas others require the singer to perform for the majority of a 3-hour production.
Environmental factors that may affect the performing artist include substances that performers are exposed to in the workplace. If the patient's onset of voice difficulties coincided with the start of rehearsals or performance for a particular production, the clinician should ask questions regarding the types of sets and props used. For example, Richter and colleagues (2002) found that singers, actors, and other performing artists occasionally are exposed to ambient stage conditions that contain irritating agents such as aromatic diisocyanates used to create a mound as part of the production's set, spore-producing fungi contained in cork granulate, cobalt and aluminum used in paint pigments, and fine quartz sand capable of entering the alveolae. Recent investigations into the harmful consequences of some theatrical special effects have resulted in restrictions being placed by performing artists’ unions (such as Actors Equity) on the use of such effects as glycol-based theatrical smoke (Pendergrass, 1999; Rossol & Hinkamp, 2001; Teschke et al., 2005).
However, some demands are common among professional singers of all styles. How often does the singer perform? Does he or she employ a consistent warm-up and cool-down exercise regimen? How often, where, and for how long does the singer rehearse? If the singer travels by plane, how soon after his or her flight is he or she required to sing? If the singer is a premenopausal woman, is she often required to sing during her premenstrual period? Does the touring performer have “down time,” and, if so, what does he or she do during that time? All of these factors play an important role in the overall vocal load of the professional singer and are critical in understanding the responsibilities and expectations that he or she faces.
Business-Related Concerns
When a singer experiences vocal difficulty and has to make a decision whether or not to cancel a performance, many influences come into play in addition to medical and therapeutic factors. Often, professional singers are represented by agencies, sometimes multiple agencies in the case of a singer with an international career. These professionals who collaborate with the singer will help to consider whether or not the cancellation will cause financial hardship: whether or not the cancellation could produce a perception of unreliability among local booking agents, concert promoters, orchestral conductors, or music festival managers; and if the cancellation will result in the forfeiting of monetary deposits for performance venues and merchandising contracts. Frequent cancellations also can affect the singer's relationship with the agents themselves.
There are additional concerns regarding long-term effects of proceeding with the performance despite illness. How critical is this performance to the singer's overall career? Will there be press coverage with subsequent performance reviews? Will the concert be recorded for later broadcast or recording sales? Will it be televised? These factors must be considered seriously when formulating a cost-benefit analysis of cancellation versus suboptimal performance or compensatory adjustments to repertoire or range.
Considerations for Treatment
Professional singers who are touring frequently usually cannot attend multiple treatment sessions. In fact, they often have difficulty returning to the clinic where they were initially evaluated simply due to their traveling schedule. Therefore, it often is necessary to provide the patient with behavioral exercises through a self-directed home practice regimen at the time of the evaluation. This also may include follow-up through teletherapy methods, depending upon specific licensing and regulatory factors. For many singers, the initial home program involves detailed discussions regarding behavioral and environmental precautions to help control laryngopharyngeal reflux, recommendations for peri-performance practices, and establishing consistent warm-up/cool-down and vocal unloading regimens that can be implemented reasonably without multiple sessions of therapy.
Because inaccurate recall of medical information may lead to nonadherence to treatment regimens (Snelgrove, 2006), clinicians should provide the patient with written instructions for all recommendations and behavioral exercises, as well as copies of diagnostic data and reports, if available. Because many professional singers use the internet to maintain communication with family and friends during concert tours, they often will travel with a laptop or notebook computer. Most patients will appreciate having a copy of their endoscopic video file for their personal medical records, particularly if their follow-up examination will be completed at another clinic.
When Surgery Is Indicated
Most surgeons prefer to exhaust all medical and behavioral options before they will consider performing phonosurgery on a patient who is a professional singer, though this largely depends on the diagnosis. Anxiety among professional singers is a natural response, and often the speech-language pathologist (SLP) is involved intimately in providing information regarding expected outcomes and peri-operative behavioral treatment. Because a surgical recommendation usually provides a temporary hiatus in the patient's touring schedule, clinicians may indicate preoperative voice therapy to teach behavioral exercises that the patient will use postoperatively and to reinforce the surgeon's recommendations regarding postoperative voice recovery.
Because postoperative recommendations for total vocal rest vary widely between surgeons (Behrman & Sulica, 2003), it is important that the surgeon and SLP communicate consistently to ensure that they provide reliable information to the patient. The preoperative voice therapy session also is an ideal time to establish plans for adjustments to the patient's environment postoperatively, including changes to the patient's outgoing message on his or her voicemail, procuring materials to support primary written communication, and identifying situations and environments the patient should avoid during the period of vocal rest the surgeon prescribes. It is critical that the clinician provides the recommendations he or she makes during this session in written format for convenient future reference. Postoperative vocal rest may also mean “modified” vocal rest, a period during which the clinician expects the patient to use the voice to communicate in normal conversational speech, but not to resume performance. The team should prescribe the period of vocal rest, whether total or modified, on a case-by-case basis. The decision-making process is shaped by the severity of vocal pathology and surgical intervention and by the patient's expected vocal load when resuming performance. Most often, patients will benefit from adjustments to their training to ensure adequate healing of the surgical site while continuing to maintain the high level of muscle tone and neuromuscular control that the patient has worked for so many years to develop. The surgeon and the SLP, through effective communication and collaboration, can create a plan for return to vocal function that strikes a balance between avoiding the deleterious effects of prolonged vocal inaction with the need to maintain a laryngeal environment that will effectively facilitate adequate postoperative tissue recovery. Although the literature suggests some degree of individual variability (Blaylock, 1999; Milbrath & Solomon, 2003; Motel, Fisher, & Leydon, 2003; Vinnturi et al., 2001; Welham & Maclagan, 2004), the patient often will benefit from the establishment of warm-up and cool-down exercises they perform at the beginning and at the end of their day, respectively. This is particularly true for the singer who has not had previous formal singing training. These exercises often may include pitch glide tasks performed using lip/tongue trills (Titze, 1996), arpeggios, humming, and messa di voce exercises (Titze et al., 1999).
Suggestions for Continuing Education
It may be challenging for the SLP who is not a singer to obtain adequate continuing education to develop a sense of confidence with this specialized patient population. Working with professional singers is, by contrast, a lifelong educational process. In order to expand their competencies to work effectively with professional singers, SLPs can
  • take private singing lessons;

  • observe singing lessons in the studios of master singing teachers (SLPs can learn much by watching others participate in the training process);

  • sit in on rehearsals for choirs (amateur and professional), operas, and musical theatre;

  • enjoy musical performances such as operas or musical theatre productions, these are much more engaging in person than on recordings;

  • take seminars or classes in bodywork techniques that are commonly used during singing training, such as Lessac, Alexander or Feldenkreis;

  • attend concerts by local bands or singers of various styles, or attend regional music festivals;

  • read books on vocal pedagogy and singing;

  • sign up for a subscription to periodicals that follow the music profession;

  • join the Voice Foundation and attend the annual Symposium;

  • attend meetings of the National Association of Teachers of Singing, the National Opera Association, OperaAmerica, and the Voice and Speech Trainers Association;

  • develop collaborative relationships with the singing teachers and arts administrators in your local area; and/or

  • apprentice with a mentor.

The professional singer is a challenging, unique, and extremely rewarding patient population to work with. As the collaborative relationships between singers, SLPs, otolaryngologists, teachers of singing, and voice trainers/coaches continues, the result will be a fruitful merging of art and science that will enhance the professions for the benefit of all.
Comments/questions about this article? Visit our ASHA Community and join the discussion!
Comments/questions about this article? Visit our ASHA Community and join the discussion!×
References
Behrman, A., & Sulica, L. (2003). Voice rest after microlaryngoscopy: Current opinion and practice. Laryngoscope, 113, 2182–2186. [Article] [PubMed]
Behrman, A., & Sulica, L. (2003). Voice rest after microlaryngoscopy: Current opinion and practice. Laryngoscope, 113, 2182–2186. [Article] [PubMed]×
Blaylock, T. R. (1999). Effects of systematized vocal warm-up on voices with disorders of various etiologies. Journal of Voice, 13, 43–50. [Article] [PubMed]
Blaylock, T. R. (1999). Effects of systematized vocal warm-up on voices with disorders of various etiologies. Journal of Voice, 13, 43–50. [Article] [PubMed]×
Dailey, S. D. ( 2005, March). Management of the professional voice user. Presented at University of Wisconsin Department of Surgery, Division of OTO-HNS, Madison, WI.
Dailey, S. D. ( 2005, March). Management of the professional voice user. Presented at University of Wisconsin Department of Surgery, Division of OTO-HNS, Madison, WI.×
Elias, M. E., Sataloff, R. T., Rosen, D. C., Heuer, R. J., & Spiegel, J. R. (1997). Normal strobovideolaryngoscopy: Variability in healthy singers. Journal of Voice, 11, 104–107. [Article] [PubMed]
Elias, M. E., Sataloff, R. T., Rosen, D. C., Heuer, R. J., & Spiegel, J. R. (1997). Normal strobovideolaryngoscopy: Variability in healthy singers. Journal of Voice, 11, 104–107. [Article] [PubMed]×
Koufman, J. A., Radomski, T. A., Joharji, G. M., Russell, G. B., & Pillsbury, D. C. (1996). Laryngeal biomechanics of the singing voice. Otolaryngology – Head and Neck Surgery, 115, 527–537. [Article] [PubMed]
Koufman, J. A., Radomski, T. A., Joharji, G. M., Russell, G. B., & Pillsbury, D. C. (1996). Laryngeal biomechanics of the singing voice. Otolaryngology – Head and Neck Surgery, 115, 527–537. [Article] [PubMed]×
Lundy, D. S., Casiano, R. R., Sullivan, P. A., Roy, S., Xue, J. W., & Evans, J. (1999). Incidence of abnormal laryngeal findings in asymptomatic singing students. Otolaryngology – Head and Neck Surgery, 121(1), 69–77. [Article] [PubMed]
Lundy, D. S., Casiano, R. R., Sullivan, P. A., Roy, S., Xue, J. W., & Evans, J. (1999). Incidence of abnormal laryngeal findings in asymptomatic singing students. Otolaryngology – Head and Neck Surgery, 121(1), 69–77. [Article] [PubMed]×
Milbrath, R. L., & Solomon, N. P. (2003). Do vocal warm-up exercises alleviate vocal fatigue? Journal of Speech, Language, and Hearing Research, 46, 422–436. [Article]
Milbrath, R. L., & Solomon, N. P. (2003). Do vocal warm-up exercises alleviate vocal fatigue? Journal of Speech, Language, and Hearing Research, 46, 422–436. [Article] ×
Motel, T., Fisher, K. V., & Leydon, C. (2003). Vocal warm-up increases phonation threshold pressure in soprano singers at high pitch. Journal of Voice, 17, 160–167. [Article] [PubMed]
Motel, T., Fisher, K. V., & Leydon, C. (2003). Vocal warm-up increases phonation threshold pressure in soprano singers at high pitch. Journal of Voice, 17, 160–167. [Article] [PubMed]×
Pendergrass, S. M. (1999). Determination of glycols in air: Development of sampling and analytical methodology and application to theatrical smokes. American Industrial Hygiene Association Journal, 60, 452–427. [Article] [PubMed]
Pendergrass, S. M. (1999). Determination of glycols in air: Development of sampling and analytical methodology and application to theatrical smokes. American Industrial Hygiene Association Journal, 60, 452–427. [Article] [PubMed]×
Richter, B., Löhle, E., Knapp, B., Weikert, M., Schlömicher-Their, J., & Verdolini, K. (2002). Harmful substances on the opera stage: Possible negative effects on singers’ respiratory tracts. Journal of Voice, 16, 72–80. [Article] [PubMed]
Richter, B., Löhle, E., Knapp, B., Weikert, M., Schlömicher-Their, J., & Verdolini, K. (2002). Harmful substances on the opera stage: Possible negative effects on singers’ respiratory tracts. Journal of Voice, 16, 72–80. [Article] [PubMed]×
Rossol, M., & Hinkamp, D. (2001). Hazards in the theater. Occupational Medicine, 16, 595–608. [PubMed]
Rossol, M., & Hinkamp, D. (2001). Hazards in the theater. Occupational Medicine, 16, 595–608. [PubMed]×
Roy, N., Tanner, K., Gray, S. D., Blomgren, M., & Fisher, K. V. (2003). An evaluation of the effects of three laryngeal lubricants on phonation threshold pressure (PTP). Journal of Voice, 17, 331–342. [Article] [PubMed]
Roy, N., Tanner, K., Gray, S. D., Blomgren, M., & Fisher, K. V. (2003). An evaluation of the effects of three laryngeal lubricants on phonation threshold pressure (PTP). Journal of Voice, 17, 331–342. [Article] [PubMed]×
Sandage, M. (ed.), et al. (2005). The role of the speech-language pathologist, teacher of singing, and the speaking voice trainer in voice habilitation. Position statement: American Speech-Language-Hearing Association. Available at http://www.asha.org/docs/html/TR2005-00147.html
Sandage, M. (ed.), et al. (2005). The role of the speech-language pathologist, teacher of singing, and the speaking voice trainer in voice habilitation. Position statement: American Speech-Language-Hearing Association. Available at http://www.asha.org/docs/html/TR2005-00147.html×
Sataloff, R. T. (2005). Arts medicine: An interdisciplinary paradigm. Ear, Nose & Throat Journal, 84, 462–463.
Sataloff, R. T. (2005). Arts medicine: An interdisciplinary paradigm. Ear, Nose & Throat Journal, 84, 462–463.×
Snelgrove, S. (2006). A consideration of memory in terms of information giving. Nursing Times, 102(9), 26–28. [PubMed]
Snelgrove, S. (2006). A consideration of memory in terms of information giving. Nursing Times, 102(9), 26–28. [PubMed]×
Sundberg, J. (2001). Level and center frequency of the singer's formant. Journal of Voice, 15, 176–186. [Article] [PubMed]
Sundberg, J. (2001). Level and center frequency of the singer's formant. Journal of Voice, 15, 176–186. [Article] [PubMed]×
Teschke, K., Chow, Y., van Netten, C., Varughese, S., Kennedy, S. M., & Brauer, M. (2005). Exposures to atmospheric effects in the entertainment industry. Journal of Occupational and Environmental Medicine, 2, 277–284.
Teschke, K., Chow, Y., van Netten, C., Varughese, S., Kennedy, S. M., & Brauer, M. (2005). Exposures to atmospheric effects in the entertainment industry. Journal of Occupational and Environmental Medicine, 2, 277–284.×
Titze, I. R. (1996). Lip and tongue trills: What do they do for us? Journal of Singing, 52(3), 51–52.
Titze, I. R. (1996). Lip and tongue trills: What do they do for us? Journal of Singing, 52(3), 51–52.×
Titze, I. R., Lemke, J., & Montequin, D. (1997). Populations in the U.S. workforce who rely on voice as a primary tool of trade: A preliminary report. Journal of Voice, 11, 254–259. [Article] [PubMed]
Titze, I. R., Lemke, J., & Montequin, D. (1997). Populations in the U.S. workforce who rely on voice as a primary tool of trade: A preliminary report. Journal of Voice, 11, 254–259. [Article] [PubMed]×
Titze, I. R., Long, S., Shirley, G. I., Stathopoulos, E., Ramig, L. O., Carroll, L. M., & Riley, W. D. (1999). Messa di voce: An investigation of the symmetry of crescendo and decrescendo in a singing exercise. Journal of Acoustical Society of America, 105, 2933–2940. [Article]
Titze, I. R., Long, S., Shirley, G. I., Stathopoulos, E., Ramig, L. O., Carroll, L. M., & Riley, W. D. (1999). Messa di voce: An investigation of the symmetry of crescendo and decrescendo in a singing exercise. Journal of Acoustical Society of America, 105, 2933–2940. [Article] ×
Vinnturi, J., Alku, P., Lauri, E. R., Sala, E., Sihvo, M., & Vilkman, I. (2001). Objective analysis of vocal warm-up with special reference to ergonomic factors. Journal of Voice, 15, 36–53. [Article] [PubMed]
Vinnturi, J., Alku, P., Lauri, E. R., Sala, E., Sihvo, M., & Vilkman, I. (2001). Objective analysis of vocal warm-up with special reference to ergonomic factors. Journal of Voice, 15, 36–53. [Article] [PubMed]×
Welham, N. V., & Maclagan, M. A. (2004). Vocal fatigue in young trained singers across a solo performance: A preliminary study. Logopedics Phoniatrics Vocology, 29(1), 3–12. [Article]
Welham, N. V., & Maclagan, M. A. (2004). Vocal fatigue in young trained singers across a solo performance: A preliminary study. Logopedics Phoniatrics Vocology, 29(1), 3–12. [Article] ×
Wingate, J. M., Brown, W. S., Shrivastav, R., Davenport, C., & Sapienza, C. M. (2007). Treatment outcomes for professional voice users. Journal of Voice, 21, 433–449. [Article] [PubMed]
Wingate, J. M., Brown, W. S., Shrivastav, R., Davenport, C., & Sapienza, C. M. (2007). Treatment outcomes for professional voice users. Journal of Voice, 21, 433–449. [Article] [PubMed]×
We've Changed Our Publication Model...
The 19 individual SIG Perspectives publications have been relaunched as the new, all-in-one Perspectives of the ASHA Special Interest Groups.