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the artistic nature of their voices. In order to identify the needs of the professional singer

and actor, it is important to understand the demands of vocal quality and artistic delivery.

Singers…may be compared to professional athletes, who are more likely to suffer

muscular injuries than the general population due to their high physical demand” (Behlau

& Murry, 2006). When seeking a voice assessment at a voice center, a singer can expect

to undergo a full evaluation with the interdisciplinary team prior to receiving any

treatment for his or her voice disorder. See ncvs.org/e-learning/expect.html for more

information on what to expect at a voice center visit. Usually, once a singer has decided

to seek medical attention for a voice problem, medical professionals understand the

gravity of the situation. “Professional voice users as a group have the highest of work

ethics and an unusually good appreciation of their state of health. They generally will not

seek out the help of a laryngologist unless they are certain that something specific is

wrong with their vocal tract; their level of anxiety as to its ramifications on their career

will be great, and they will likely downplay the extent of the ailment and its duration”

(Rubin et al. Chapter 40, 2006, p. 638).

Most voice centers assess voice by taking a detailed case history, directly

evaluating the larynx via endoscopy (visualization of anatomy) and stroboscopy (function

and movement of the mechanism), perceptual assessment of the voice by the clinician,

quality of life measures by the patient (using the Singing Voice Handicap Index), reflux

symptoms (using the Reflux Severity Index), acoustic measures (S:Z ratio, maximum

phonation time, MDVP [perturbation measures], voice range profile, average pitch during

comfortable /a/ and conversation) and aerodynamic measures (subglottal pressure and

airflow measures).

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According to an informal survey of speech pathologists from major voice centers

(personal communications, 2012), the main differences in the assessment of singers

versus non-singers are the type of questions asked in the case history, the thoroughness of

the voice range profile, and the scope of the perceptual assessment. During the

assessment, patient history information should include information about practice habits,

warm-ups, travel schedule, vocal load, nutrition and eating schedule, sleep schedule,

hydration and hygiene. Nonmedical issues could include family trouble, trouble with a

singing coach or teacher, trouble with a producer or colleagues, and/or difficulty with a

particular role or type of singing. For significant psychological singing issues, referrals

may be made to a vocal psychotherapist. Diane Austin, director of the Music

Psychotherapy Center in New York is an excellent reference (see

www.psychodramany.com/diane/ for more information).

Environmental considerations at performing venues and vocal load should be

seriously considered. It should be known that professional voice users often self-

medicate, and even use their colleagues’ medication, sometimes incorrectly. This can be

dangerous and should be looked out for and educated against by the voice team. During

the evaluation, it is ideal for a patient to view a recording of the laryngeal exam in order

to understand the larynx, see the pathology or lack of pathology, and to cause the

performer to feel involved. If possible, a video of the singer giving a performance should

be reviewed by the voice care team to determine vocal habits while singing in a

professional environment. Specific evaluation procedures for singers may be found in

“Acute Assessment of Professional Singers” (Schlömicher-Their & Weikert, 2006), “The

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