Introduction
Research indicates a high prevalence of vocal pathologies among student singers. First-year music theatre (MT) singers, in particular, demonstrate a markedly higher incidence of vocal fold pathologies (40%) compared to classical singers (0%) and contemporary commercial music singers (17%)¹. Maintaining vocal health through strong interoceptive awareness and auditory-perceptual discrimination is crucial for performance optimization and vocal longevity.

Objective
To investigated the relationship between student singers’ perception of vocal health and clinically measured signs of voice disorders.

Method
A cross-sectional observational cohort design was employed. Twenty-six first-year MT students underwent comprehensive voice assessments at a Voice Research Clinic conducted by a multidisciplinary team comprising ear, nose and throat specialists (ENTs), speech pathologists, and researchers. Assessments included case history questionnaires, patient-reported outcome measures (PROMs), auditory-perceptual ratings, videostroboscopic laryngeal examinations, and acoustic and aerodynamic analyses.

Results
The cohort comprised 16 females, 9 males, and 1 gender non-binary participant, aged 17–20 years. Sixteen participants reported symptoms consistent with voice disorders, including vocal fatigue, loss of high-pitch range, and breathiness. None scored above the clinical cut-off for voice disorder on the **Voice Handicap Index-10 (VHI-10)**, and only one participant exceeded the cut-off score (≥20) on the **Singing Voice Handicap Index (SVHI)**.
Videostroboscopic examination revealed that 46% (12/26) of participants presented with organic pathologies—such as mid-membranous phonotraumatic lesions and vocal process granulomas—exceeding prevalence rates reported by Lloyd et al. Of those 12 students, 9 reported symptoms of a voice disorder. These findings suggest a disconnect between MT students’ self-perceived vocal health and the clinical indicators of vocal pathology, indicating an inverse relationship between perceived and actual vocal health.

Conclusion
Preliminary results suggest that many young MT singers may lack the awareness or ability to accurately connect their vocal function with their perceived vocal health and self-efficacy in singing. The findings highlight the importance of implementing universal voice screening for MT students to enhance prevention, promote vocal health awareness, and improve long-term performance and career outcomes for emerging performers.