AMATEUR CHOIR SINGERS : SELF-IMAGE , DIFFICULTIES AND SYMPTOMS OF THE SINGING VOICE Coralistas amadores : auto-imagem , dificuldades e sintomas na voz cantada

(1) Speech-language Pathologist and Audiologist. Master’s Degree in Sciences – Speech-language Pathology and Audiology Graduate Program University of São Paulo, Brazil. (2) Choir conductor; Professor of the Music and Art course of the Sagrado Coração University – Graduated Musician at the Sagrado Coração University; Master’s Degree Music – “Júlio de Mesquita Filho” State University. (3) Speech-Language Pathologist and Audiologist, Doctor in Sciences, Professor of the Speech-Language Pathology and Audiology Department at the Bauru School of Dentistry/University of São Paulo FOB/USP. (4) Speech-Language Pathologist and Audiologist, Doctor in Communication Disorders, Professor of the Speech-Language Pathology and Audiology Department at the Bauru School of Dentistry/University of São Paulo FOB/USP.


INTRODUCTION
Choral singing is characterized by group activity, and diversity is one of its main characteristics.Its demands vary depending on the amateur or professional nature and on the repertoire characteristics, which also vary widely 1 .
The literature states several factors the can impact directly the performance of a choir singer.They include the vocal classification 2 , vocal changes related to age since maturation until senescence [3][4][5][6] , and also the great diversity of the participants regarding singing experience in choirs 7,8 .
One of the characteristics of amateur choirs is the great evasion of singers 9 .Generally, the new participants are inexperienced and often have little In this context, studies about the impact of choral singing in the voice of the elderly who are beginners in singing revealed decrease of vocal complaints e difficulties during singing, and also verified increase of the vocal range 4,5 .However, elderly singers who never received proper training can present vocal alterations common with aging 16 .
The purpose of this study was to investigate the self-perception, difficulties and the presence of negative symptoms after singing in amateur choir singers with different vocal classifications, ages and levels of experience.

METHOD
This prospective, cross-sectional study, counted with 125 members of five choirs conducted by the same professional, being 95 women and 30 men, aged between 18 and 77 years.
No exclusion criteria were used, since we sought to understand the characteristics and vocal difficulties of the members of these groups.
After signing the informed consent, the singers individually answered a partly written and partly multiple choice questionnaire, which addressed: 1. Identification data: age, time of singing experience, vocal classification (soprano, alto, tenor or bass); 2. Information regarding self-perception of the singing voice: regarding vocal quality -hoarse, breathy or normal, volume -too weak, too strong or adequate and timbre -clear, dark or neither; 3. Difficulties during singing: emission of high or low notes, falsetto, passaggio to high and low notes, difficulties in the emission of fortes and pianos, difficulties related to vocal attacks and cuts (beginning and end of the part of a song), difficulties related to breathing and breath support, and no difficulties; 4. Presence or absence of vocal symptoms after singing: hoarseness, vocal fatigue, weakness; laringo-pharyngeal discomfort, itchiness, pain or stinging in the laryngeal are, sensation of lump or tightness in the throat, strain in the neck area.
The singers were divided according to the vocal classification, age, and time of singing experience.This work was submitted to the appraisal of the ethics committee of the Bauru School of Dentistry and was approved under process nº 115/2005.The answers of the questionnaires were charted and the comparison of the groups for each variable studied was performed using the Fisher's Exact Test, Qui-square Test, and Comparison of Proportion, with significance levels of 5%.knowledge about how to protect their vocal health 10.However, it is usually possible that people who are beginning the practice of singing may develop a healthy and pleasant voice with appropriate training 11.Musical experience seems to have different effects on the singing performance and is considered important for the musical development 12 .Braun-Janzen and Zeine 13 investigated the levels of interest and knowledge of vocal production of singers, concluding that amateur singers were susceptible to developing negative symptoms.Cohen et al. 14 investigated the quality of life in elderly singers with vocal complaints, concluding that less experienced singers present greater vocal handicap than professional singers.
An important step for beginning singers is the vocal classification, in which they are divided in high vocal range ("soprano" for women and "tenor" for men) and low vocal range ("alto" for women and "bass" for men).Due to the vocal characteristics and demands observed in each vocal classification, it is common that singers have more ease in performing determined tasks and greater difficulties in others.
In an investigation of vocal use of choir singers, Ribeiro and Hanayama 2 concluded that sopranos present a higher number of overall difficulties and that altos present higher number of multiple vocal symptoms, such as difficulties changing registers and in the emission of high notes in low intensity.
The singing activity can be performed by people of different ages or profiles, who normally practice amateur singing seeking entertainment.The literature has been making growing reference to the use of the singing voice in middle aged and elderly singers.Spiegel, Sataloff and Emerich 15 cite that the prevalence of vocal abuse and health problems related to age can be important factors to be considered.Moreover, vocal changes during the normal aging process may be related to implications such as decrease of the breathing volume and respiratory control during singing 16 .Other vocal alterations caused by aging include decrease of maximum phonation time, breathiness, asthenia, instability, hoarseness, inability to sustain phonation, inadequate loudness and loss of vocal range 17 .However, age related changes in the habitual frequency seem to be less prominent or even absent in trained voices 18 .The vocal maturation of professional singers shows phonatory stability, promoting the optimization of breathing control and phonatory abilities.This way, it is possible that well prepared elderly professionals can add training and experience to their vocal performance, and not present significant vocal changes with aging 9 .
-Group C: 26 experienced singers, from 2.5 to 5 years -Group D: 18 very experienced singers, over 5 years The aspects investigated refer to the singer's vocal self-perception, their main difficulties practicing singing and to the presence of negative symptoms after singing.
Comparing the vocal classifications (Table 1), we observed that the altos present greater difficulties with high notes than sopranos (p=0.001) and that the basses have the same difficulty against tenors (p=0.032).The opposite also occurred for the female voices, as the sopranos referred greater difficulty in producing low notes than the altos (p=0.007).Moreover, the basses referred more difficulty with the transition of the low to the high register in comparison to tenors (p=0.018).Regarding the negative symptoms, the altos referred more vocal fatigue after singing than sopranos (p=0,021).

RESULTS
For a more didactic placement of results, the groups were divided according to the selected variables as follows: and none the experienced singers reported this symptom.Likewise, the most experienced singers referred better intensity control for singing.The literature states that trained voices 25 have decreased risks of presenting alterations 13,26,27 .Therefore, the negative self-perception is more common in younger singers.The more experienced singers referred significantly higher positive self-perception, such as adequate intensity then the less experienced singers.
We did not find significant data regarding the difficulties during singing considering age and experience, suggesting that these difficulties are related to the vocal classification.The findings related to the difficulties in reaching high or low notes evidence the purpose of each vocal type.In other words, sopranos and tenors sing predominantly in higher keys and altos and basses sing predominantly in lower keys.The difficulties with the passaggio to high notes, referred by the basses suggest that the vocal equalization during the passaggio is tricky 28 .The basses already present reduced range for high notes, which can hamper The performance of further studies involving choir singers can evaluate whether the quality of voice of theses singers is consistent with the vocal complaints reported.Moreover, the familiarity with the vocal features of choir singers can offer important information to the conductor, who can adjust the vocal techniques, redirecting them to the singer's difficulties, and collaborating with a better performance of the singing voice and with the singer's vocal health.

CONCLUSION
The difficulties found in signing are related to the vocal classification, and do not depend on age or experience.Symptoms such as vocal fatigue are related to the vocal classification and to the level of singing experience.The group of inexperienced singers presented greater occurrence of hoarseness after singing.The negative self-perception is also related to the vocal classification and level of experience and the positive self-perception is more common in experienced singers.
the coordination of the laryngeal muscles, where the activity of the cricoarytenoid muscle should surpass the activity of the thyroarytenoid muscle.
In the analysis of negative symptoms after singing, we observed statistically significant index of vocal fatigue in altos in comparison to the sopranos.These findings contradict the data of a similar study 29 , which found higher index of vocal fatigue in sopranos than in altos.The researchers stated that the causes and the context of the vocal fatigue may be the incorrect vocal use in singing high notes in high intensities 30 , which favors more vocal fatigue in sopranos, which is the contrary of our finding.We did not observe differences of this nature in the comparison of the groups by age.However, most of the complaints came from the young adults, followed by the adults and the elderly, respectively.The groups of inexperienced singers or singers with little experience presented high occurrence of hoarseness after singing in comparison to the more experienced singers.This way, we reinforce that long term vocal training is a determinant factor for the maintenance of a healthy voice [3][4][5]13,16,18,24,25 .