Songbirds Must Sing: How Artistic Voice Users Perceive Their Voice in Times of COVID-19

Vocal Health Assessment of Professional Performers Returning to the Stage After the COVID-19 Pandemic Shutdown

OBJECTIVES/HYPOTHESIS

This study assessed the vocal health of performers returning to full-time performance after the COVID-19 pandemic shutdown and investigated how differences in voice usage, exposure to voice care professionals, and vocal pathology before and during the pandemic contributed to variability in self-perceived and instrumental vocal outcome measures.

STUDY DESIGN

This was a prospective, case-control observational study conducted at a single outpatient site.

METHODS

Twenty-two patients, 11 cases and 11 controls, were enrolled for the study. All participants were full-time singing professionals prior to the COVID-19 pandemic. Cases were recruited from patients presenting to a tertiary care voice center for vocal or pharyngeal complaints. Controls were healthy volunteers recruited from the general population of professional singers in the surrounding metropolitan area. All participants provided responses to the Voice Handicap Index-10, Evaluation of Ability to Sing Easily, and Laryngopharyngeal Measure of Perceived Sensation validated questionnaires as well as a study survey with questions regarding vocal use and history prior to and during the pandemic. All participants underwent instrumental acoustic and videostroboscopic voice evaluations.

RESULTS

Cases had poorer outcome measures overall and were more likely to report their voices were worse at study enrollment when compared to their prepandemic perception (P = 0.027). Cases tended to be older and less likely to have pursued alternative employment during the pandemic that involved increased speaking voice use (27% vs 55%), but these differences were not statistically significant.

CONCLUSIONS

There was a variable response among performers to the prolonged hiatus from performing during the COVID-19 pandemic. Those with poorer outcomes tended to be older and may have used their voice less during the pandemic. These findings are consistent with detraining periods in the exercise physiology literature and support the construct of treating vocal performers as vocal athletes.

Vocal Self-Perception of Singers During COVID-19 Pandemic

OBJECTIVE

to compare the self-perception of vocal fatigue and use of singing voice during the COVID-19 pandemic between professional and amateur singers and to relate this self-perception with vocal use characteristics during this period.

METHODOLOGY

Participants were 121 singers divided into professional singers group (PSG) (12 men and 20 women) comprising singers who depended exclusively on singing as a profession and an amateur singers group (ASG) (37 men and 52 women) of singers who did not depend exclusively on singing for their livelihood. All answered online questionnaires through Google Forms ®. Sociodemographic and vocal characteristics were investigated before and during the pandemic; symptoms of vocal fatigue were assessed through the vocal fatigue index (VFI); and self-perception of use of singing voice through the evaluation of the ability to sing easily protocol for Brazil (EASE-Br).

RESULTS

In the comparison between groups, the PSG presented higher scores of vocal fatigue in fatigue and vocal limitation (P = 0.045), vocal restriction (P = 0.002), and recovery with vocal rest (P = 0.008) domains than did the ASG. There was no difference between the groups regarding the use of singing voice. Based on the relationship between self-perception and vocal use characteristics during the pandemic, it was observed that the presence of vocal complaint was the only factor associated with self-perception of fatigue symptomatology in both groups. Regarding the self-perception of the current status of the singing voice, singing time, the presence of vocal complaints, the need to increase visual concentration, and the perception of vocal worsening during the pandemic were considered predictive for amateur singers. For professional singers, vocal complaints and vocal training were predictors for self-perception of the current status of the singing voice.

CONCLUSION

Professional singers presented with higher scores of vocal fatigue than did amateur singers. The symptomatology of vocal fatigue was associated with the presence of vocal complaints in both groups. However, self-perception of the current status of the singing voice was different between the groups and was associated with vocal training for professional singers and characteristics of vocal demand of singing voice during the pandemic period for amateur singers.

Dysphonia and Throat Clearing in Singers During the COVID-19 Pandemic in Brazil

OBJECTIVE

The COVID-19 pandemic in Brazil affected the lives of singers, with negative impacts of the disease on the voice, such as dysphonia and throat clearing. This study aims to evaluate the presence of dysphonia and throat clearing in singers during the COVID-19 pandemic in Brazil.

MATERIAL AND METHODS

This is a cross-sectional analytical study with a sample of 154 singers from all over Brazil. Data collection was carried out online, by completing the questionnaire created by the researcher using Google Forms. The following were considered the outcome variables: voice impairment and throat clearing. The bivariate analysis was performed to test the relationship between COVID-19 infection and voice impairment, COVID-19 infection and throat clearing, COVID-19 infection and laryngeal complaints (voice impairment and throat clearing).

RESULTS

In this study, the mean age of the singers was 35.8 (Standard deviation = ±10.2 years) and 59.2% were female. Most of them worked as professional singers (81.1%) and had more than 10 years of professional experience (57.4%), mainly singing pop music (85.4%). A total of 62% reported vocal alterations during the COVID-19 infection and 53% had vocal alterations after the infection, with 44.0% reporting the onset of throat clearing after the infection. There was a significant association between COVID-19 infection and having voice impairment (P = 0.03; prevalence ratio - PR: 2.33; CI: 1.04-5.46). An association was observed between the onset of throat clearing and the occurrence of COVID-19 infection (P = 0.001; PR: 9.13; CI: 2.47-64.42).

CONCLUSIONS

The results indicated that there is an association between COVID-19 infection and complaints of dysphonia and throat clearing in Brazilian singers. This study demonstrates the importance of guidance to singers infected with COVID-19 by health voice processionals.

COVID-19: Impact on the Musician and Returning to Singing; A Literature Review

OBJECTIVE

The purpose of this study was to review current literature of the impact of COVID-19 on musicians and returning to singing.

METHODS

A comprehensive search of peer-review articles was completed using PubMed, GoogleScholar, Scopus, and Web of Science. The search was completed using many key terms including voice, hoarseness, dysphonia, aphonia, cough, singers, and public speakers. The bibliography from each article found was searched to find additional articles. The search process revealed 56 peer-reviewed articles, 18 primary articles, ranging from the years 2019 to 2020.

CONCLUSION

COVID-19 has had a major impact on singers and other musicians worldwide. It can affect the voice and can lead to paresis/paralysis of laryngeal nerves to long-term changes in respiratory function. There is a risk from aerosolization/droplet formation transmission with singing, and with playing wind and brass instruments that can be mitigated by following COVID-19 guidelines. Ways to reduce possible transmission during singing and instrument play include virtual rehearsals or performances, mask-wearing, instrument covers, smaller choirs, performing outside, excellent ventilation being socially distanced, shorter rehearsals, regularly cleaning commonly touched surfaces and washing hands, avoiding contact with others, and temperature screening.

Losing Life's Sparkle: Experiences of Canadian Choral Musicians During the COVID-19 Pandemic

Background. Singing in choirs, which previous research has identified as supporting wellbeing, has been restricted and altered during the COVID-19 pandemic. Purpose. The purpose of this study is to investigate and describe the experience of music-making for musicians in professional and semi-professional choirs in Canada 18-22 months into the COVID-19 pandemic. Method. Semi-structured interviews were conducted with 11 participants and analyzed using interpretive description. Findings. Four themes: (1) increased negative feelings associated with the music-making experience due to COVID-19 restrictions, (2) isolation and disconnection, (3) recognizing how music-making aids in their own mental health, the participants used music-making to help their communities cope with the pandemic, and (4) adapting in response to COVID-19 reinforced music-making's importance. Implications. Understanding how the COVID-19 pandemic has altered Canadian choral musicians' experience of music-making can help occupational therapists in supporting choral musicians return to this meaningful occupation.

Effect of COVID-19 Quarantine on Voice Handicap Index in Female Classical Singers

OBJECTIVE

This study aimed to verify the impact of vocal deviation in the quality of life of classical female singers over the quarantine imposed by the COVID-19 pandemic through self-assessments.

METHODS

Fifty five professional classical female singers filled out an online questionnaire including general questions such as identification, age, professional experience time, vocal classification, time of singing, and rehearsal studies. They all answered the protocol Classical Singing Handicap Index, adapted for this research, which analyses three subscales: Disability, Handicap, and Impairment.

RESULTS

There was no significant difference in the perceived total handicap index score (40% of 120 points). Regarding the three domains analyzed, Disability was significantly higher than Impairment (P = 0.012). In addition, the correlation with the variables identified that Impairment subscale showed a negative correlation with the variable hours of rehearsal (r = -0.335, P = 0.040).

CONCLUSIONS

The COVID-19 quarantine does not seem to cause a significant impact on the voice of professional classical female singers probably due to their degree of experience and vocal preparation.

Singing Voice Symptomatology Following Presumed SARS-CoV-2 Infection

The impact of continued COVID-19 sequelae on singers' vocal function has yet to be determined. An online survey of singers who have contracted SARS-CoV-2 infection was designed and administered globally. Participants (n = 1,153) were recruited in Africa, the Americas, Asia, Australia, and Europe. Survey questions included demographics, peri- and post-SARS-CoV-2 infection symptoms, and self-reported sequelae attributed to long-COVID. The survey was made available in English, Portuguese, Spanish, and Traditional and Simplified Mandarin Chinese. Data were statistically analyzed to provide a useful summary of the sample and to evaluate associations between long-COVID and singers' vocal function. We found that age, gender, and vaccination status were not significantly correlated to a change in singing voice in our sample. However, severity of infection was statistically correlated with a change in singing voice. Of the 34 signs and symptoms presented, lingering cough, shortness of breath, and chronic fatigue were significantly correlated with a change in singing voice. These data and their analyses have added to our understanding of this growing population's unique vocal needs, and may inform strategies for singing voice habilitation in COVID-19 survivors.

Prevalence of Mental Health Complaints Among Performing Arts Students Is Associated With COVID-19 Preventive Measures

The aim of this study was to investigate the effect of COVID-19 preventive measures on the mental health of performing arts students. In a prospective cohort study, performing arts students (N = 213) from Codarts Rotterdam, University of the Arts, were invited to monitor their health during one academic year (September 2019–May 2020). Every month, students completed items on mental health complaints, stress, and sleep quality. Chi-square tests and repeated-measures ANOVA with deviation contrasts were performed to investigate whether COVID-19 preventive measures were associated with changes in mental health complaints, stress scores, and sleep quality. During the COVID-19 lockdown, subjective mental health, Mental Health Inventory-5 (MHI-5), and items on loneliness were additionally completed by the respondents. A total of 98 students (46.0%) were included in the analyses. The 3-month prevalence of mental health complaints was significantly higher during the COVID-19 lockdown compared to the two pre-COVID-19 periods (p < 0.001). Mean stress scores were significantly lower for February (35.20) and March (36.41) when compared to the overall mean (40.38). Sleep quality scores (mean) were significantly higher for April (6.90), and May (6.89) when compared to overall mean (6.58). Furthermore, at least 75.5% of the participants dealt with moderate to very severe loneliness in all 3 months during the COVID-19 lockdown. During lockdown, performing arts students perceived less stress and their sleep quality increased. However, the prevalence of mental health complaints increased. Besides, 3 out 4 students dealt with moderate to very severe loneliness.

COVID-19 and the teacher's voice: self-perception and contributions of speech therapy to voice and communication during the pandemic

OBJECTIVES

We aimed to analyze the vocal self-perception of Brazilian teachers and their communication needs, vocal signs and symptoms, and voice-related lifestyles during the coronavirus disease (COVID-19) pandemic and, based on this information, to develop guidance materials intended for dissemination to these teachers and the general community.

METHODS

An online questionnaire designed for this survey was distributed via the researchers' networks and was available for completion by any teacher, except those who were not working at the time. There were 1,253 teachers from all over Brazil, of both sexes, covering a wide age range, working at different levels of education, and most with more than ten years of experience. Descriptive and inferential analyses of the data were performed.

RESULTS

On comparing the prepandemic period with the current one, participants indicated voice improvements. In contrast, they presented symptoms such as dry throat, effort in addressing remote classes, hoarseness after classes, and difficulties with the use of headphones, among others. They further indicated stress, general fatigue, impact of the pandemic on mental health, and the overlapping of many home tasks with professional tasks. Some smoked, and others hydrated insufficiently.

CONCLUSION

Although teachers generally noticed voice improvements during the pandemic, a proportion of them perceived worsening of voices. Many indicated several factors in which speech-language pathologists could guide them with the aim of improving performance and comfort during remote and hybrid classes, an initiative that will positively impact not only their voice and communication but also their quality of life.