Association Between the Development of Pediatric Voice Disorders and Singing in Children’s Choir

Abstract

IMPORTANCE Pediatric vocal fold pathology is important because having a healthy voice free from disorders is crucial in a child's emotional and educational development. OBJECTIVE To determine whether there is an association between singing in a children's choir and the development of voice disorders. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of children (aged 8 to 14 years) singers selected from local children's choirs and nonsingers selected from local schools evaluated at Clarós Otorhinolaryngology Clinic in Barcelona, Spain, from October 2016 through April 2018. EXPOSURES Singing for a mean time of 7.5 hours per week for 2.5 years. MAIN OUTCOMES AND MEASURES The primary outcome of the study was the prevalence of voice disorders measured using videostroboscopy. The obtained values were analyzed statistically and used to compare the characteristics of the children and the frequency of voice disorders between the groups. RESULTS Of 1495 enrolled children (745 male [49.8%]; median age, 9.3 years [range, 8-14 years]), 752 were singers and 743 were nonsingers. No differences in baseline characteristics were observed between the groups. Voice disorders were more frequent in the nonsinging group than in the singing group (32.4% vs 15.6%; difference, 16.8%; 95% CI, 12.3%-21.4%). Of 12 voice disorders considered in this study, all 12 were more frequent in the nonsinging group. Functional voice disorders were more frequent in the nonsinging group than in the singing group (20.2% vs 9.4%; difference, 10.8%; 95% CI, 7.2%-14.3%), as were organic voice disorders (12.2% vs 6.1%; difference, 6.1%; 95% CI, 2.6%-9.6%). CONCLUSIONS AND RELEVANCE Voice disorders were less common among children in the cohort who sing in choirs, possibly because of voice training and the commonly observed habit of attending regular ear, nose, and throat examination. Voice disorders may be prevented in nonsinging children if the same solicitude for voice is observed.

Association of Singing With the Development of Pediatric Voice Disorders—Reply

“…We would like to clarify that both groups were evaluated in exactly the same way for LPR and reflux symptoms. However, owing to limitations caused by the uncertain nature of LPR diagnosis and no agreement across specialists on diagnostic criteria, this matter was just an additional observation in our study and was not included in the results (LPR was discounted from the voice disorders in our research) . Sataloff noted that there may be an association between singing training and the increased incidence of LPR owing to increased intra-abdominal pressure.…”

Association of Singing With the Development of Pediatric Voice Disorders

“…To the Editor We thank Clarós et al for their study investigating the association between singing in a children’s choir and the development of voice disorders. The authors reported a significantly greater number of voice disorders in nonsingers compared with singers, thus emphasizing the importance of introducing conscientious voice care in nonsinging children.…”

“…In addition, the authors remarked that instances of vocal trauma could result from shouting during team sports or playing with other children . They further postulated that this could be owing to the possibility that there are lower levels of vocal care awareness among nonsinging participants.…”

“…Nevertheless, Clarós and colleagues have made important contributions to our understanding of how vocal training and choral participation may decrease the risk of development of voice disorders among prepubescent children. Further work is necessary to strengthen the nature of this association.…”

Association of Singing With the Development of Pediatric Voice Disorders

“…To the Editor Clarós et al should be complimented on the article “Association Between the Development of Pediatric Voice Disorders and Singing in Children’s Choir,” published online in March. The study was important.…”