Recognizing the Invisible: Singing with Postural Orthostatic Tachycardia Syndrome

Objective:
Postural Orthostatic Tachycardia Syndrome (POTS) is clinically defined as a heart rate increase ≥30 bpm (for adults) within 10 minutes of standing or head-up tilt in the absence of orthostatic hypotension; the standing heart rate is often ≥120 bpm (Grigoriou et al., 2015). Symptoms include light-headedness, fatigue, sweating, tremor, anxiety, palpitation, exercise intolerance and near syncope on upright posture (Agarwal et al., 2007). The incidence of POTS appears to be growing, though it is unclear if this is an emerging epidemic or the result of increased recognition (Brinth et al., 2018). In either case, voice professionals are likely to see more individuals affected by this chronic condition in their studio or clinic. The effects of POTS in the high-demand voice user is not well understood. This study will explore the experience of singers with a medical diagnosis of POTS, and aims to provide a practical resource to both singers navigating their diagnosis and voice professionals who may find themselves in collaboration with them.

Methods/Design:
This mixed-method study will collect data through 1) an online survey with closed and open-ended questions, and 2) case-study interviews with three active singers with a POTS diagnosis.

Singers who are 18 years or older and have a medical diagnosis of POTS will be invited to respond to queries related to their general health, POTS-related symptoms, individual singing training and experience and perception of general vocal function. Qualitative data will be analyzed using template analysis and quantitative data through crosstab analysis.

Case study interviews will be conducted with selected participants, identified in the online survey, who report a diagnosis of POTS without comorbidities that affect the voice. Interview transcription, member-checking and data coding will be completed to look for commonalities and differences that may be of practical use to singers and voice professionals (e.g., studio teachers, choral directors, voice therapists, etc.).

Results & Conclusions:
Results are pending data collection and analysis. It is hoped that these findings will inspire future research and inform habilitation and rehearsal practices.