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Jornal da Sociedade Brasileira de Fonoaudiologia

versão On-line ISSN 2179-6491

J. Soc. Bras. Fonoaudiol. vol.24 no.3 São Paulo  2012 



Influence of complaints and singing style in singers voice handicap



Felipe MoretiI; Maria Emília Barros de ÁvilaII; Clara RochaII; Maria Cristina de Menezes BorregoII; Gisele OliveiraII; Mara BehlauI

ICentro de Estudos da Voz - CEV - São Paulo (SP), Brazil; Department of Speech-Language Pathology and Audiology, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brazil
IICentro de Estudos da Voz - CEV - São Paulo (SP), Brazil

Correspondence address




The aim of this research was to verify whether the difference of singing styles and the presence of vocal complaints influence the perception of voice handicap of singers. One hundred eighteen singing voice handicap self-assessment protocols were selected: 17 popular singers with vocal complaints, 42 popular singers without complaints, 17 classic singers with complaints, and 42 classic singers without complaints. The groups were similar regarding age, gender and voice types. Both protocols used - Modern Singing Handicap Index (MSHI) and Classical Singing Handicap Index (CSHI) - have specific questions to their respective singing styles, and consist of 30 items equally divided into three subscales: disability (functional domain), handicap (emotional domain) and impairment (organic domain), answered according to the frequency of occurrence. Each subscale has a maximum of 40 points, and the total score is 120 points. The higher the score, the higher the singing voice handicap perceived. For statistical analysis, we used the ANOVA test, with 5% of significance. Classical and popular singers referred higher impairment, followed by disability and handicap. However, the degree of this perception varied according to the singing style and the presence of vocal complaints. The classical singers with vocal complaints showed higher voice handicap than popular singers with vocal complaints, while the classic singers without complaints reported lower handicap than popular singers without complaints. This evidences that classical singers have higher perception of their own voice, and that vocal disturbances in this group may cause greater voice handicap when compared to popular singers.

Keywords: Voice; Quality of life; Evaluation studies; Protocols; Music; Questionnaires




In the voice field, the Voice Handicap Index - VHI is one of the most well-known and used self-rating questionnaire that evaluates the impact of a voice problem(1). This questionnaire was developed in the United States(2) and validated in almost 20 countries(3), including Brazil(4), where it received the name Índice de Desvantagem Vocal - IDV. Even though the VHI has indisputable validity and reliability, its sensitivity to evaluate singers is poor, since the perception of the handicap produced by the singing voice handicap is not approached by this questionnaire(5).

In order to address this population, the VHI was adapted to evaluate the singing voice, both in English(6) and French(7). Popular and classical singers have different musical education, thus they have diverse singing techniques, vocal demands and self-perception of their own voices. Therefore, they deserve different tools in order to reach greater analysis specificity. Recently, the phoniatrician Franco Fussi proposed two specific versions of this questionnaire for classical and popular singing: Modern Singing Handicap Index - MSHI and Classical Singing Handicap Index - CSHI(8). These two versions were translated and culturally adapted to the Brazilian Portuguese as Índice de Desvantagem para o Canto Moderno - IDCM(9) (Appendix 1) and Índice de Desvantagem para o Canto Clássico - IDCC(10) (Appendix 2). The comparability of the handicap evaluated by both questionnaires has not been known yet.

For this reason, the purpose of this research was to investigate whether there are differences between the two singing styles and whether the presence of vocal complaint influences the perception of the vocal handicap by singers.



This research was approved by the institutional ethics committee under the number 0819/11. Data were collected from the institution database under the authorization of the individual in charge. The answers from the self-assessment questionnaires of popular and classical singers were used. One hundred eighteen questionnaires were selected and distributed into four groups: 17 popular singers with vocal complaint - PSWC, 42 popular singers without vocal complaint - PSWoC, 17 classical singers with vocal complaint - CSWC and 42 classical singers without vocal complaint - CSWoC. The groups were demographically similar, with a mean age of 29.5 years (p=1.000). Sixty-six of them were women - 44 sopranos and 22 altos - and 52 men - 26 tenors and 26 basses - (gender distribution: p=0.776 and singing voice classification distribution: p=0.665).

Both questionnaires have specific questions directed the respective singing styles and are composed of 30 items, equally divided into three subscales: disability (functional domain), handicap (emotional domain) and impairment (organic domain). The questions are answered according to their frequency (never, almost never, sometimes, almost always and always). Each subscale has a maximum score of 40 points and the questionnaire total score corresponds to 120 points. The higher the score, the greater is the vocal handicap perceived.

The level of significance adopted was 5% (0.05). The ANOVA parametric test was used for the statistical analysis.



Although the scores were different for the singing styles, the order of the higher to the lower handicap was the same: impairment (organic domain), followed by disability (functional domain) and handicap (emotional domain). The higher scores were observed in the CSWC (Table 1).

Individuals with vocal complaint from both styles presented with higher handicap when compared to the individuals without complaints for all subscales (Table 2).



Aspects such as high vocal demand, use of voice in vocal extremes, lack of technical expertise and limited singing experience(5-8) may explain the bigger deviation detected by the impairment subscale(11) and that consequently, places the individuals in a situation of potential vocal risk(6). Usually classical singers have a greater demand and a better technique related to the use of voice when compared to popular singers(12), this is probably why they are more sensitive to the perception of a voice problem. Therefore, classical singers without vocal complaint report less voice handicap, whereas classical singers with vocal complaint report greater handicap, possibly because a voice problem may pose their career to a high risk(10). On the other hand, small voice deviations may even be used by popular singers to compose certain styles and to give them a vocal signature(9).

The presence of voice complaint was determinant to the manifestation of voice handicap(13). This fact shows the sensitivity of each questionnaire regarding the style for popular and classical singers with vocal complaints(11,14).



Classical and popular singers report higher impairment (organic domain), followed by disability (functional domain) and handicap (emotional domain). However, the degree of perception varies according to the singing style and to the presence of vocal complaint.

Classical singers with vocal complaint present greater vocal handicap than popular singers also with vocal complaint, while classical singers without vocal complaints report less handicap than the popular singers with vocal complaint. This fact indicates that the classical singer has more perception of his/her own voice and that a vocal deviation for this group of professionals may produce more vocal handicap than for popular singers.



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Correspondence address:
Felipe Moreti
R. Machado Bittencourt, 361/1001, Vila Clementino
São Paulo (SP), Brasil, CEP: 04044-905

Received: 9/2/2011
Accepted: 12/12/2011
Conflict of interests: None



Research performed at Centro de Estudos da Voz - CEV - São Paulo (SP), Brazil.



Appendix 1 - Click to enlarge



Appendix 2 - Click to enlarge

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