Differences between female singers with phonotrauma and vocally healthy matched controls in singing and speaking voice use during 1 week of ambulatory monitoring

Laura E. Toles, Andrew J. Ortiz, Katherine L. Marks, James A. Burns, Tiffiny Hron, Jarrad H. Van Stan, Daryush D. Mehta, Robert E. Hillman

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Purpose: Previous ambulatory voice monitoring studies have included many singers and have combined speech and singing in the analyses. This study applied a singing classifier to the ambulatory recordings of singers with phonotrauma and healthy controls to determine if analyzing speech and singing separately would reveal voice use differences that could provide new insights into the etiology and pathophysiology of phonotrauma in this at-risk population. Method: Forty-two female singers with phonotrauma (vocal fold nodules or polyps) and 42 healthy matched controls were monitored using an ambulatory voice monitor. Weeklong statistics (average, standard deviation, skewness, kurtosis) for sound pressure level (SPL), fundamental frequency, cepstral peak prominence, the magnitude ratio of the first two harmonics (H1–H2), and three vocal dose measures were computed from the neck surface acceleration signal and separated into singing and speech using a singing classifier. Results: Mixed analysis of variance models found expected differences between singing and speech in each voice parameter, except SPL kurtosis. SPL skewness, SPL kurtosis, and all H1–H2 distributional parameters differentiated patients and controls when singing and speech were combined. Interaction effects were found in H1–H2 kurtosis and all vocal dose measures. Patients had significantly higher vocal doses in speech compared to controls. Conclusions: Consistent with prior work, the pathophysiology of phonotrauma in singers is characterized by more abrupt/ complete glottal closure (decreased mean and variation for H1–H2) and increased laryngeal forces (negatively skewed SPL distribution) during phonation. Application of a singing classifier to weeklong data revealed that singers with phonotrauma spent more time speaking on a weekly basis, but not more time singing, compared to controls. Results are used as a basis for hypothesizing about the role of speaking voice in the etiology of phonotraumatic vocal hyperfunction in singers.

Original languageEnglish (US)
Pages (from-to)199-209
Number of pages11
JournalAmerican Journal of Speech-Language Pathology
Issue number1
StatePublished - Jan 2021
Externally publishedYes

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Developmental and Educational Psychology
  • Linguistics and Language
  • Speech and Hearing


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