Intl J Lang Comm Disor - 2023 - Levett - Amateur Choir Singers Does Good Vocal Health Matter

Received: 3 March 2022 Accepted: 30 January 2023
DOI: 10.1111/1460-6984.12863
RESEARCH REPORT
Amateur choir singers – Does good vocal health matter?
Jo Levett1 Tim Pring2
1 Independent Researcher
2 Department of Language and
Abstract
Communication Science, City University Background: Many amateur singers enjoy singing in choirs. They are likely
of London, London, UK to lack the training and expertise of professional singers and this may have an
Correspondence impact on their vocal health.
Jo Levett, Kent Community Health NHS Aims: To assess the experiences of amateur singers, their use of warm-up and
Foundation Trust, Children’s Therapies,
cool-down sessions, their vocal health, their sources of help and advice and their
The Heathside Centre, Heath Road,
Coxheath, Maidstone, Kent, ME17 4AH, reactions to receiving a diagnosis and treatment.
UK. Methods and Procedures: A questionnaire was sent to amateur choir singers.
Email: jolevettslt@gmail.com
Quantitative data on their use of warm-up and cool-down activities were col-
lected and the singers rated how frequently they experienced adverse voice
symptoms after singing. Qualitative data were collected from singers who had
sought advice about their voice and from those who had received a diagnosis
and treatment.
Outcome and Results: Most choirs used warm-up sessions but few used cool-
down. Singers who participated in choir warm-ups experienced significantly less
vocal symptoms. Individual warm-ups were ineffective. Singers who had previ-
ously had a diagnosis continued to have significantly higher symptom scores. A
quarter of the singers who had neither sought help nor had a diagnosis had high
scores. Singers appeared uncertain about who to consult for help. Those who
saw a speech and language therapist were much more likely to receive a diagno-
sis and treatment either by the therapist or by referral to an ear, nose and throat
specialist. Those receiving treatment were mainly positive about it and likely to
complete a course of therapy.
Conclusions and Implications: Warm-up sessions performed by choirs are
helpful in avoiding voice symptoms and are recommended. The presence of
singers who are unaware of potential damage to their voices is a concern. A sim-
ple rating system, as used in this research, may act to alert them to the dangers.
Choir leaders could be more active in advising singers and refer them to profes-
sionals where necessary. Speech and language therapists appear more sensitive
to their problems and could be a first point of contact.
1286 © 2023 Royal College of Speech and Language Therapists.wileyonlinelibrary.com/journal/jlcd Int J Lang Commun Disord. 2023;58:1286–1293.
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LEVETT and PRING 1287
KEYWORDS
amateur singers, cool-downs, vocal health, warm-ups
WHAT THIS PAPER ADDS

What is already known on this subject
∙ Poor vocal health may occur in amateur singers and lead to voice disorders
which will reduce the demonstrated benefits of regular singing. They may be
less aware than professional singers of potential hazards and may not know
how to sing in a way that ensures good vocal health. There has been less
research on the extent of voice problems in amateurs or of the actions they
may take to resolve the vocal difficulties they encounter.
What this paper adds to the existing knowledge

∙ This survey demonstrates that choir warm-ups were effective in helping to
avoid common symptoms associated with voice problems. A large minority of
singers who had not sought help for voice problems had high symptom scores
on our assessment. Singers frequently turned to a singing teacher for help.
Those who consulted a speech and language therapist were much more likely
to be referred for further investigation and treatment.
What are the potential or actual clinical implications of this work?

∙ We present a simple subjective measure of symptom severity which succeeds
in distinguishing between singers who warm up their voices and those who
do not and between singers who have received a past diagnosis and those
who have not. There are a number of indications in this research that ama-
teur singers are unsure if they need help and are uncertain who can offer it. In
these circumstances the use of a simple measure of the severity of vocal abuse
may be useful.
INTRODUCTION sessions before and after singing are widely regarded as

good practice and the survey assessed whether these ses-
Singing is good for you! Studies show that it benefits sions are used by amateur singers and their choirs and
physical and mental health and reduces social isolation whether they are helpful in avoiding several common
(Apfelstadt, 2016; Goldenberg, 2018; Kang et al., 2018). symptoms associated with voice problems.
However, poor vocal health may occur in amateur singers Smith and Sataloff (2003) and Stegman (2003) were early
and lead to voice disorders which will reduce these ben- advocates of the need to warm up the voice prior to singing.
efits. Professional singers are likely to be aware of these The former speculate that the variability in the use of
problems and research has studied their vocal health warm-ups at that time was due to the inexperience of
habits and the therapeutic journeys of professional singers choirs by conductors more accustomed to working with
who have experienced voice disorders. However, amateur orchestras. Both offer accounts of the value of warming up
singers may be less aware of these hazards and may not the voice and of exercises that may be used. Strong evi-
know how to sing in a way that ensures good vocal health. dence for the warm-ups comes from objective measures
There has been less research on the extent of voice prob- of voice quality. Elliot et al. (1995) found that warm-ups
lems in amateurs or of the actions they may take to resolve lowered phonation threshold pressure. The reduction var-
the vocal difficulties they encounter. ied across singers and was consistent with their subjective
This paper reports the information gathered from a large reports of the effect on their voice quality. Amir et al. (2005)
survey of amateur singers. Vocal warm-up and cool-down used acoustic measures to demonstrate improved voice
1288 AMATEUR CHOIR SINGERS
quality of young female singers following vocal warm- cutoff score which indicates vocal risk. Over half of church
up and Mezzedimi et al. (2020) found that fundamental choir singers in a study by Sharma et al. (2021) reported
frequency (F0) increased after warm-up. problems such as difficulty accessing high notes, loss of
DeFatta and Sataloff (2012), summarising the evidence vocal endurance, pitch breaks, hoarseness, dryness and
at the time, stated that the case for warm-ups had been discomfort in the throat. These authors express concern
widely accepted although the scientific evidence was not about the lack of knowledge of voice in their respondents
always consistent. Despite inconsistencies in the evidence, and on the need to educate singers to avoid future problems
they failed to find any studies that reported adverse out- (Ravall & Simberg, 2020; Sharma et al., 2021).
comes and added that singers often report increased pitch Although amateur and inexperienced singers may be
range, smoother transitions and overall improved ease of particularly vulnerable to voice problems, they are not
singing after warming up. However, they stated that the alone. A study by Phyland et al. (1999) of professional
case for cool-downs was less secure. singers found that 44% had had a diagnosed vocal symp-
Not all studies agree. Milbrath and Solomon (2003) tom in the last year and that 69% had had one or more
found no benefit of vocal warm-up exercises on phonation instances of vocal disability, and Donahue et al. (2014)
threshold pressure and self-perceived phonatory effort. found that over half of a sample of musical theatre stu-
Kirsh et al. (2013) found that suboptimal singing (being dents had at least one current negative vocal symptom.
outside a comfortable range and being too loud) led to These figures may be misleading, however. Although non-
fatigue and reduced vocal quality but that warm-ups were singing controls in the former study had significantly
not associated with vocal well-being. fewer problems, they reported quite high levels of difficulty
Vocal cool-downs are thought to help relax the mus- suggesting that the reporting threshold was low and the
cles of the larynx and prepare them for conversational musical theatre students may have been inexperienced as
speech. However, less evidence exists of their value. Ver- they were in the first year of their training.
dolini Abbott et al. (2012) found that resonant voice These studies vary in a number of ways. They target dif-
exercises following vocal loading led to a better reduction ferent types of singers, amateur and professional and those
in inflammation of vocal folds in vocally healthy adults undertaking voice training. They differ in the means they
than either continuation of spontaneous speech or com- use to assess and define the severity of voice symptoms.
plete voice rest. Although Ragan (2016) found objective Some use formal assessments such as the VoiSS and the
measures inconclusive, singers’ perceptions were that a Modern Singing Handicap Index (MSHI), more frequently
cool-down regime reduced vocal fatigue and felt the psy- participants are asked which symptoms they experience
chological implications of this positive response should not and how frequently or how seriously they do so. The for-
be underestimated. Mezzedimi et al. (2020) found that the mer are consistent and known to practitioners of voice
F0 of female singing students reduced following a cool- therapy and provide cutoff scores for diagnostic purposes
down session, confirming a positive effect in aiding voice but are not generally available to singers, particularly ama-
recovery and reducing vocal fold tension. teur singers, as a guide to whether they should seek advice
Smith (2018) believed that vocal warm-ups and cool- about the care of their voice. The latter are quicker and
downs preserve vocal health and that omitting them may offer a simple guide to singers but are, inevitably, more
risk injury to the voice. She expressed concern about ama- subjective. These factors may account for the variation in
teur singers who join choirs with enthusiasm but with little the estimates of voice disorder. The studies are consistent
knowledge of how to sing healthily. They may have had lit- in detecting singers with voice symptoms but vary quite
tle singing training, lack expertise and be unaware of the widely as to their frequency. Large numbers of professional
importance of the vocal warm-up and/or cool-down. and amateur choir singers experience vocal problems, per-
Researchers have conducted surveys to assess the preva- haps for different reasons. Professionals may be better at
lence of voice difficulties in singers. Pestana et al. (2017) maintaining their vocal health, but they sing more fre-
conducted a meta-analysis of 11 previous studies of differ- quently and in more stressful conditions and are more
ent types of singers and found that nearly half (46.09%) aware of their voice and are more likely to detect problems
reported experiencing dysphonia. Ravall and Simberg when they arise. Amateurs sing less and for enjoyment
(2020) found that 21% of the choir singers in their study had but have less awareness of the potential damage to their
two or more vocal symptoms which they took to indicate voices.
a functional voice disorder. Those with demanding sched- Few studies have assessed whether amateur singers use
ules and with allergies and asthma were more likely to warm-ups and cool-downs and whether these are helpful
have symptoms. Rosa and Behlau (2017), who specifically in moderating possible voice symptoms. The present study
targeted amateur choir singers, asked their respondents is a survey of amateur singers and their choirs. We report
to complete the Voice Symptom Scale (VoiSS) in order to demographic data on choir members and whether their
assess their voices. More than half (51.5%) were above the choirs use warm-ups and cool-downs and whether choir
members benefitted from these activities. A measure of cool down sessions, the activities used in these sessions
whether and how frequently choir members experienced and the extent of their vocal symptoms. Five prominent
vocal symptoms was used to compare choirs who do or do vocal symptoms were offered (frequent throat clearing,
not use warm-ups and cool-downs. vocal fatigue, loss of range, hoarseness and pitch breaks)
It was anticipated that some of the singers taking part and singers were asked whether they experienced them
will have had problems with their voices and may have often, sometimes or not at all. The second part used
sought advice or received a diagnosis of a voice disorder. open-ended questions to explore the participants’ experi-
Singers were asked whether this was the case and were ence of their symptoms and of the help they may have
asked to describe their experiences. There is relatively little sought. Where they had received a diagnosis, it asked who
literature on singers’ experiences of voice therapy and the had given it, what therapies had been recommended and
findings are not very positive. Adessa et al. (2017) found whether these had been beneficial. Participants responded
that less than half of singers who were referred to voice anonymously and were not required to answer all the
therapy completed the course of treatment. Singers are not questions.
alone in their poor adherence to voice therapy. Portone Singing in choirs is popular. There are over 750 UK mem-
et al. (2008) studied referrals by physicians to speech- ber choirs of the National Association of Choirs (National
language pathologists and found that 38% did not attend. Association of Choirs, 2006–2019) and over 2000 UK soci-
Of the remainder, 47% dropped out after an initial evalu- ety members of the National Operatic & Dramatic Society
ation of their condition. Hapner et al. (2009) found that (National Operatic & Dramatic Association, 2019). As a
65% dropped out before completing therapy. It is unclear result, a large number of responses was expected. The
why singers stop attending therapy. These poor attendance survey link was distributed in the following ways:
rates may reflect a lack of confidence that voice therapy
can be of benefit and/or little understanding of whom ∙ Facebook pages of local and national musicians, choirs
to consult for help with voice problems. A vocal health and amateur dramatics networks.
survey by Weekly et al. (2017) found that amateur and ∙ Emails to local choirs.
professional voice users chose the most readily available ∙ Personal presentations to local choir and drama groups.
medical approach, rather than approaches more suited to ∙ Personal contacts in choirs.
the vocal issue needing treatment. Other sources acknowl-
edged the importance of the relationship between therapist Snowball sampling occurred, with the link being for-
and singer in motivating singers to adhere to therapy (van warded to singers via social media and email. This proce-
Leer & Connor, 2010) and named rapport between singer dure was expected to result in a large random sample of
and therapist as well as a collaborative, cooperative rela- singers representing a large selection of amateur choirs.
tionship between singer, therapist and singing teacher to Inclusion criteria were that singers were amateurs, that
be crucial (Goffi-Fynn & Carroll, 2013). Amateur singers they were over 18 years of age and that they sang at least
may be uncertain how to handle their voice problems and twice a month.
may not know to whom to turn for advice. Open-ended Statistical analysis of the data was carried out using
questions in the present survey sought further information the Statistical Package for the Social Sciences (SPSS 26).
on this. With regard to the qualitative analysis of responses, and
This paper uses singers’ ratings of their vocal symptoms the question about whether the advice or treatment that
to assess the value of warm ups and cool down sessions. We singers received was effective or not, only a minority of par-
also use the ratings to compare singers who have or have ticipants sought advice or had treatment and answered this
not previously experienced problems with their voices. question. Of these many responded yes or no, some mak-
Qualitative data allow us to gain insight about singers ing no further comment, some expanding on their answer
who have sought advice or received treatment for their with comments. A few of these comments are included in
problems. the results section.
Ethical approval for the research was given by the Uni-
versity of Wales Trinity Saint David Research Ethics &
METHOD Integrity Code of Practice.
Information from amateur choir singers was obtained via

a SurveyMonkey questionnaire. SurveyMonkey Audience RESULTS
was used because it enables information to be sent as a
link in an email or circulated via social media. The ques- Questionnaires were returned by 852 participants. Singers
tionnaire was in two parts. The first gathered quantitative who sang less than twice a month or were under 18 were
information on the participants, their use of warm up and excluded. A few were excluded as they sang primarily as
T A B L E 1 Numbers and percentages of choir members with Table 4 gives the mean symptom score for singers using
warm-ups and cool-downs different forms of warm-up. Although the differences in
Cool- the symptom scores are not large, it appears that the use of
Warm-ups downs a choir warm-up is beneficial and that only marginal gains
Choir only 390 51.0% 18 2.4% occur from individual warm-ups. Statistical analysis using
Individual only 67 8.8% 43 5.6% independent t tests confirmed these impressions. A com-
Both 196 25.7% 3 0.4% parison of singers with and without choir warm-ups was
None 100 13.1% 670 87.7% highly significant, t (724) = 2.81 p < 0.01, d = 0.24. That
No response 11 1.4% 30 3.9% for singers using or not using individual warm-ups was not
significant t (724) = 0.84, p > 0.4.
Further evidence that some singers had experienced
T A B L E 2 Numbers and percentages of choir members concerning vocal symptoms is available from answers to
participating in warm up activities the questions about receiving a diagnosis of a voice dis-
% of order or of seeking advice about possible symptoms. One
Number of warm up % of all hundred and twenty-one had either sought advice or had
respon- respon- respon- received a diagnosis.
dents dents dents Table 5 gives the distribution of the scores of individual
Singing scales 518 86.3 67.8 singers on this measure. It shows that nearly 70% of singers
Humming scales 364 60.7 47.6 had scores of three or less (equivalent to three symptoms
Breathing exercises 339 56.5 44.4 sometimes or one often and one sometimes). The remain-
Stretches 305 50.8 39.9 der had higher scores indicating more severe problems
Lip trills 277 46.2 36.3 (mean 5.19, SD 1.85).
Singing through straw 17 2.8 2.2 A comparison of the symptom scores of singers who had
Others 146 24.3 19.1 received a diagnosis of voice difficulties (mean = 3.66, SD
= 2.03) and those who had not (mean = 2.68,SD = 1.81)
gave a strongly significant result (t (723) = 3.90. p < 0.001).
soloists or were professionals. As a result, 764 responses In itself, this result is not surprising. We do not know
remained for the analysis. Individual respondents omitted when singers received their diagnosis. Some are experienc-
to answer some questions as permitted by the instructions. ing few problems at present, others have high symptom
These omissions led to inconsistencies in the totals listed. scores, suggesting that they are continuing to have diffi-
Choir members predominantly identified as female (547 culties. They are continuing to sing despite their problems.
female, 158 male, 59 did not reply). Members were from 18 What we do not know—cannot know—are the numbers of
to over 75 years of age (mean 55.07, SD 14.55) and many singers who may have stopped singing as a result of their
had been singing in choirs for a long time; 410 for over difficulties.
10 years. A more concerning situation arises when we consider
Table 1 gives the numbers of choir members who took singers who have neither sought help nor had a diagnosis.
part in warm up and cool down sessions. Warm up ses- Table 6 summarises the data from the previous table, using
sions were common, cool down sessions infrequent. Both four and above as a dividing point (below and above the
could be undertaken either by the choir as a whole or by mean for singers with a diagnosis). It shows that nearly a
individual members and sometimes by both. quarter of singers who have not sought help or received a
Table 2 gives the number and percentage of participants diagnosis have high scores.
who used the different warm up exercises. Most choirs Open-ended questions on the survey were aimed at
used several exercises (mean 3.24, SD 1.50) with singing those singers who had experienced adverse consequences
scales most frequently used. for their voices as a result of singing. Where did they turn
Table 3 summarises the vocal symptoms experienced by for advice and, if they consulted professionals, who did
participants. Participants were asked to indicate how fre- they see, what diagnosis was offered and was any treatment
quently they experienced each of the five vocal symptoms offered effective?
and these were scored never = 0, sometimes = 1 and often Sixty-three singers sought advice but were not referred
= 2 giving a score out of 10 for each singer. The last col- elsewhere and did not receive a diagnosis. Forty-seven
umn gives the total score for all singers and is an indication sought advice, went on to consult specialists and received
of the extent of each symptom. Frequent throat clearing a diagnosis. Eleven received a diagnosis but without
was the commonest symptom and occurs ‘often’ more than indicating an initial source of advice. The three main
twice as frequently as the others. sources of advice were singing teachers, doctors (general
TA B L E 3 Vocal symptoms experienced by participants

Never Sometimes Often Overall score
Frequent throat clearing 314 326 88 502
Vocal fatigue 329 368 30 428
Loss of range 389 299 39 377
Hoarseness 383 321 23 367
Pitch breaks 423 289 15 319
TA B L E 4 Symptom scores for different forms of warm-up T A B L E 6 Summary of data from Table 5, showing distribution
Mean of singers with symptom scores above and below four
symptom No advice
n score SD or
Choir only 375 2.71 1.86 diagnosis Diagnosis
Own only 65 3.08 2.08 Scores 0–3 442 27
Both 189 2.51 1.62 Scores 4+ 162 31
No warmup 98 3.12 2.01 667 58
727 2.75 1.84
T A B L E 7 Referrals by singing teachers, doctors and speech

TA B L E 5 Distribution of singers by severity of vocal symptoms and language therapists
No advice or Advice no Not referred Referred
Score All singers diagnosis diagnosis Diagnosis
Singing teachers 33 11
0 74 68 1 2
Doctors 20 7
1 121 108 7 5
Speech and language therapists 2 23
2 174 147 14 13
3 136 119 10 7
4 96 70 10 14
The commonest diagnoses were vocal nodules, loss of
5 75 59 9 7
voice and dysphonia and were used by ENTs and by SLTs.
6 30 19 6 5
ENTs, with the benefit of endoscopy, also offered a range
7 15 9 3 3 of more specific and more varied diagnoses. GPs favoured
8 7 4 2 1 more familiar terms such as laryngitis.
9 0 0 0 0 Singers’ responses to the advice offered appeared posi-
10 3 1 1 1 tive. Often they were told to do exercises similar to those
mean 2.76 2.56 3.69 3.66 in warm-ups and they appeared to do these thoroughly.
total 725 604 63 58 I did her (SLT) exercises 5–6 times a day as I was desperate
to sing again.
Doing the exercises twice a day, I noticed a big change in a
practitioners (GPs) or ear, nose and throat specialists series of weeks.
(ENTs)) and speech and language therapists (SLTs). Table 7 Proper warm-ups helped show my voice was better than I
gives the numbers of singers who were or were not advised thought .
to seek further help by these three groups. Straw exercises really helped.
These figures reveal a clear difference of approach to Cool-down helps.
singers asking for advice about their voice difficulties. SLTs Some singers responded positively to suggestions about
are much more likely to advise them to seek further help. their posture and breathing when singing.
The effect is highly significant (chi-square = 37.5 (2), p < It helped a lot, particularly paying attention to good
0.01). SLTs referred seventeen of the singers to ENTs; in posture.
the other six cases they offered treatment themselves or Osteo was like a miracle unlocking of tension I had held
referred to another SLT. The process varied; for example, for years.
singers referred to and offered a diagnosis by ENT were I have learnt the fundamentals of singing, beginning with
sent to SLT for treatment. breathing.
Others became more aware of their vocal health and of sions. Our data suggest that warm-ups can help to protect;
their voices. perhaps a more thorough approach is to be recommended.
I am very mindful of protecting my voice now. One hundred and twenty-one singers in the sample had
It made me appreciate how vital good health is to main- sought advice or treatment for voice problems (15.8% of
taining a good singing experience. the sample). This is a low figure when compared to pre-
Asked whether the advice/treatment they received had vious studies of professional and amateur singers (Pestana
helped, nearly three quarters replied positively. Some expe- et al., 2017; Phyland et al., 1999; Ravall & Simberg, 2020;
rienced further problems but had to remind themselves of Rosa & Behlau, 2017; Sharma et al., 2021) particularly as
the help previously given. There were few complaints. One our survey included past instances of difficulty. This may
singer who had six sessions of SLT remarked that suggest that many of the participants had not sought help
It helped in the short term but I was discharged too early. when they needed it. This is supported by the finding that a
One who replied no was dissatisfied but is still singing. quarter of singers who had not sought help had high scores
on our assessment. Previous researchers have commented
that amateur singers may be poor judges of their need for
DISCUSSION help and be uncertain of where to turn to get it (Weekly
et al., 2017). In the present sample, they frequently turned
Professional singers must take good care of their voices. to a singing teacher for help. A striking finding was that
They sing frequently and in demanding circumstances, those who consulted a speech and language therapist were
have a diary of future commitments and depend on their much more likely to be referred for further investigation
voices for their livelihood. Amateur singers are differ- and treatment.
ent; they sing less often and for pleasure. They may be Previous research has found that singers make poor
less aware of the threats to their vocal health and uncer- patients, failing to attend or complete treatment (Adessa
tain how to deal with them when they arise (Ravall & et al., 2017; Hapner et al., 2009; Portone et al., 2008). This
Simberg,2020; Smith, 2018). These concerns were the moti- was not the case here. A large majority felt that therapy
vation for the present survey; the large response to the had been helpful and had completed treatment. Where
questionnaire, in itself, suggests that amateur singers want exercises had been suggested, they were continuing to use
to know more about their voices and how to care for them. them and they had become more confident and, in their
The use of vocal warm-ups and cool-downs, particularly own opinion, better singers. Advice was frequently given
the former, are widely if not unanimously seen as good that they were singing too loudly or outside their range or
practice. There is evidence that warming up improves per- that their posture was poor; things that professional singers
formance (Amir et al., 2005; Elliot et al., 1995; Mezzedimi would have learned to avoid in their training.
et al., 2020) and it is widely held that it can help to avoid Our measure of symptom severity in this study is sim-
harm to the voice. If the latter is true, amateur choirs would ple and subjective. However, it succeeds in distinguishing
be well advised to warm up. Over three quarters of respon- between singers who warm up their voices and those
dents were in choirs who warmed up and some warmed who do not and between singers who have received a
up individually. However, one hundred had neither form past diagnosis and those who have not. More sophisti-
of warm-up. A measure of the extent to which individual cated measures such as the VoiSS and the MSHI exist,
singers experience vocal symptoms was used to compare but are unlikely to be available to amateur choirs. There
choirs that warm up and those that do not. The former are a number of indications in this research that amateur
had significantly lower scores on this measure, although singers are unsure if they need help and are uncertain
the effect size was small. Individual warm-ups were inef- who can offer it. In these circumstances the use of a
fective. It may be unsurprising that they did not add to the simple measure of the severity of vocal abuse may be
protective effect of choir warm-ups, but they also failed to useful.
benefit singers without a choir warm-up.
Of course, warm-ups may vary in both their extent and AC K N OW L E D G E M E N T
thoroughness. Given six familiar warm up exercises, only This project was self-funded. No external funding was
singing scales were used in substantially more than half of gained.
choir warm-ups. This may suggest that some warm-ups are
limited in scope. Amateur choirs differ from their profes- C O N F L I C T O F I N T E R E S T S TAT E M E N T
sional cousins; they are usually in the evening, in between No conflicts of interest occurred during the authors’
other commitments and with some singers arriving late. completion of this research.
Warm-ups may be missed or rushed; individual warm-
ups may be intended but difficult to carry out. Similar D A T A AVA I L A B I L I T Y S T A T E M E N T
problems, no doubt, account for the lack of cool-down ses- N/A.
ORCID Pestana, P. Vaz-Freitas, S. & Manso, M. (2017) Prevalence of voice dis-

Jo Levett https://orcid.org/0000-0002-3134-9577 orders in singers: systematic review and meta-analysis. Journal of
Voice, 31, 722–27.
Phyland, D.J., Oates, J. & Greenwood, K.M. (1999) Self-reported voice
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https://doi.org/10.1111/1460-6984.12863

Intl J Lang Comm Disor - 2023 - Levett - Amateur Choir Singers Does Good Vocal Health Matter

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Intl J Lang Comm Disor - 2023 - Levett - Amateur Choir Singers Does Good Vocal Health Matter

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Received: 3 March 2022 Accepted: 30 January 2023

Amateur choir singers – Does good vocal health matter?

Jo Levett1 Tim Pring2

WHAT THIS PAPER ADDS

What this paper adds to the existing knowledge

What are the potential or actual clinical implications of this work?

INTRODUCTION sessions before and after singing are widely regarded as

Information from amateur choir singers was obtained via

TA B L E 3 Vocal symptoms experienced by participants

T A B L E 7 Referrals by singing teachers, doctors and speech

ORCID Pestana, P. Vaz-Freitas, S. & Manso, M. (2017) Prevalence of voice dis-

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