Performers With History of Voice Injury: Exploring Reported Pathways and Barriers to Preventive and Supportive Voice Care

Objective: Past studies show that performers are more susceptible to voice injury, have a higher incidence of voice injury, and experience greater impairment than non-performers. Certain physiologic and occupational risk factors have been documented across different performance styles and environments. Advocacy efforts that promote education and access to professional voice care can be of great benefit to this population.

Methods: An anonymous online survey was distributed via email, flyer, and social media to a target audience of performers with voice injury. The survey included inquiries about occupation, vocal symptoms, professionals seen, and treatments. Additional questions were asked about ability to recognize early signs of a voice problem, access to voice care professionals and resources, support from management and production teams, and willingness to discuss voice injury with others.

Results: The survey was completed by 151 performers with self-reported history of voice injury, representing a range of performance genres, including musical theatre, classical, choral, and popular genres. One hundred twenty-nine participants underwent laryngeal examination, 86 (66.67%) by a laryngologist, and 43 (33.33%) by a general otolaryngologist. Treatment recommendations included medical, behavioral, and procedural options, and most reported adherence to recommendations (129; 87.16%), which was a statistically significant factor in resolving vocal symptoms. Those who reported low adherence cited financial/insurance barriers or scheduling/availability conflicts. On a 100 mm VAS, participants reported high agreement that they recognize early signs of a voice problem (mean 86.80; SD 18.87), with younger participants reporting less likelihood of recognizing these signs than older participants (p=0.001). Subjects reported moderate agreement that they have resources to maintain their vocal function while performing (mean 74.76; SD 29.1), and access to a voice care team, if needed (mean 71.23; SD 36.52). Participants in the age range of 18 to 40 and those seen by a laryngologist were more likely to indicate that they had continued access to a voice care team (p=0.0016, p=0.0082). There was fairly low agreement that they have support from management and production teams (mean 50.69; SD 37.23), but highest agreement from those with symptoms >2 weeks (p=0.0105). Responses on willingness to discuss voice injuries varied, but those with a voice teacher felt more comfortable than those without (p=0.0072).

CONCLUSION: Findings of this survey, in synthesis with other studies, demonstrate a need for outreach to professional performers, performance students, management, and production teams to advocate for preventive and supportive occupational voice care.