Association of Singing With the Development of Pediatric Voice Disorders

Abstract

To the Editor We thank Clarós et al 1 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. However, we have identified several notable limitations in this study.First, the presence of laryngopharyngeal reflux disease was formally examined in singing children, but not in the nonsinging group. Only the presence of reflux symptoms in the latter was mentioned haphazardly. The significance of this should not be understated because previous studies have demonstrated the association of reflux symptoms with voice disorders 2 and dysphonia, 3 ie, the primary and secondary outcomes of the study respectively. Both groups should have been formally examined for reflux symptoms and disease. Failure to do so would mean an unfair comparison between the 2 groups, which could potentially invalidate the findings of this study.In addition, the authors remarked that instances of vocal trauma could result from shouting during team sports or playing with other children. 1 They further postulated that this could be owing to the possibility that there are lower levels of vocal care awareness among nonsinging participants. However, the study importantly also noted that singing children had higher levels of participation in team sports than nonsinging children but still reported lower levels of vocal trauma. Any assumption that singing children who also participate in team sports would shout any differently cannot be made. The contradictory nature of this analysis thus implies that there is no clear correlation between participation in team sports and the development of vocal trauma, or that the risk is greater for nonsinging children.We would also like to draw attention to the subjective nature of this study, in particular the fact that parents who were responsible for signing up their children for choir, were also accountable for reporting the presence of voice symptoms. The possibility that parents of singing children were more susceptible to hypersensitivity in detection of voice symptoms ought not to be discounted. More objective measures of detecting voice quality and symptoms should be taken into consideration to minimize bias.Nevertheless, Clarós and colleagues 1 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.