Prevalence of Vocal Fold Pathologies Among First-Year Singing Students Across Genres

Adam T. Lloyd, Julia Gerhard, Paul Baker, Donna S. Lundy, Jennylee Diaz, Michelle M. Bretl, Mario A. Landera, Mursalin Anis, Judy Marchman, David E. Rosow

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Objectives/Hypothesis: The purpose of the study was to compare the prevalence of vocal fold pathologies among first-year singing students from the classical, musical theatre, and contemporary commercial music (CCM) genres. Study Design: Prospective cohort study. Methods: Videostroboscopic examinations were rated by blinded expert raters. Vocal pathology was defined as a vocal fold abnormality on the membranous or cartilaginous portions of the vocal folds or hypomobility. Consensus among three of four raters confirmed presence of pathology. Association between genre of singer and presence of pathology, interrater reliability, and intrarater reliability were calculated. Differences in singing voice handicap, and voice use and vocal hygiene were compared. Results: Fifty-seven participants were included. Seventeen percent of CCM, 40% of musical theatre, and 0% of classical singers were found to have vocal fold pathology. Interrater reliability was 0.522 between all four raters, 0.591 between the two laryngologists, and 0.581 between the two speech–language pathologists, showing a moderate agreement (P <.0001). Intrarater reliability was 1.000 (P <.0001) for the two laryngologists and 0.452 (P =.949) and 0.622 (P =.828) for the two speech–language pathologists. Singing Voice Handicap Index-10 data across genre showed differences between CCM and classical singers. No significant differences were found in voice usage or vocal hygiene. Conclusions: No classical students were found to have vocal fold pathology, whereas CCM and musical theatre students had significantly higher prevalence of pathologies. Voice use, vocal hygiene, and physiologic phonatory differences among classical, musical theatre, and CCM genres may be risk factors for development of vocal pathology. Level of Evidence: 2b Laryngoscope, 130: 1996–2002, 2020.

Original languageEnglish (US)
Pages (from-to)1996-2002
Number of pages7
Issue number8
StatePublished - Aug 1 2020


  • Prevalence of vocal fold pathology
  • classical singing
  • contemporary commercial music
  • musical theatre
  • singers
  • singing students
  • videostroboscopy

ASJC Scopus subject areas

  • Otorhinolaryngology


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