Profile of Injured Singers: Expectations and Insights

Abstract

Objectives To discover patterns of phonotraumatic lesions in singers and investigate factors that differentiate those who underwent surgery from those who did not. We hypothesized that 1) lesion type distribution differs by age, sex, singer classification (professional/amateur), and history of formal voice training; 2) the likelihood of surgery is associated with singer classification and voice training. Study Design Retrospective. Methods Retrospective review of 438 singers with phonotraumatic lesions over a 9‐year period. Lesion type distribution was analyzed with respect to sex, age, singer classification, and voice training. The association of eventual surgery with these factors was also analyzed. Results Nodules accounted for over half of the cohort (58%), followed by pseudocysts (20%), polyps (14%), and cysts (4%). Nearly two of every three injured female singers, but fewer than one out of every three injured male singers, had nodules. In contrast, over half of the injured males had polyps, whereas only 6% of injured females had polyps. In females, polyps occurred at a later age, and in males, nodules occurred at a younger age compared to other lesion types. Only 14% of the total cohort eventually underwent surgery. Professional singers without formal voice training were almost eight times more likely to have undergone surgery than amateur singers with voice training. Conclusions Professional singers were more likely to undergo surgery than amateurs, and formal voice training was associated with a lower likelihood of surgery. The observation that polyps tended to occur in older women may have implications for the pathogenesis of vocal fold polyps. Level of Evidence 4 Laryngoscope, 132:2180–2186, 2022

Association of Genre of Singing and Phonotraumatic Vocal Fold Lesions in Singers

“…In contrast to polyps and pseudocysts, nodules were not distributed unequally across genres in this study. This finding was similar to that of Rotsides et al, who found that fibrotic lesions (the closest equivalent to nodules in this study) were highly prevalent across genres 14 . We have suspected from our clinical experience that nodules are more a derivative of the speaking voice than the singing voice.…”

“…We found that professional and amateur singers who sought care for dysphonia had similar proportions of phonotraumatic lesions. In contrast, Rotsides et al found that part‐time professional singers had a higher prevalence of laryngeal pathology than full‐time or amateur singers 14 . The difference between the two studies may be partly due to a narrower definition of pathology in the current study and perhaps partly due to a regional sample difference (Manhattan vs. Dallas).…”

“…In contrast, Rotsides et al found that part-time professional singers had a higher prevalence of laryngeal pathology than fulltime or amateur singers. 14 The difference between the two studies may be partly due to a narrower definition of pathology in the current study and perhaps partly due to a regional sample difference (Manhattan vs. Dallas). Regarding genre-based differences, we found that country/folk, gospel/jazz, and musical theater singers were more likely than pop and praise/worship singers to present with phonotraumatic lesions.…”

“…In addition, country/folk, gospel/jazz, musical theater, and opera singers were more likely than choral singers to present with phonotraumatic lesions. By comparison, Rotsides et al 14 found that singers in the musical theater and certain contemporary commercial music (CCM) genres (country, Latin, pop) had a higher prevalence of pathology than those in classical music. Finally, Lloyd et al found a higher prevalence of vocal pathology in musical theater and CCM singers than in classical singers among first‐year singing students 12 .…”

“…Phonotraumatic vocal fold lesion types (nodules, polyps, pseudocysts) were as defined previously. 14,15 Briefly, a polyp was a sessile or pedunculated lesion that could be vascular/hemorrhagic or fibrotic. A pseudocyst is a fusiform, translucent lesion with a blister-like appearance.…”