title: Clinical voice analysis of Carnatic singers.
abstract: OBJECTIVE
  Carnatic singing is a classical South Indian style of music that involves rigorous training to produce an "open throated" loud, predominantly low-pitched singing, embedded with vocal nuances in higher pitches. Voice problems in singers are not uncommon. The objective was to report the nature of voice problems and apply a routine protocol to assess the voice.
  
  
  METHODS
  Forty-five trained performing singers (females: 36 and males: 9) who reported to a tertiary care hospital with voice problems underwent voice assessment. The study analyzed their problems and the clinical findings.
  
  
  RESULTS
  Voice change, difficulty in singing higher pitches, and voice fatigue were major complaints. Most of the singers suffered laryngopharyngeal reflux that coexisted with muscle tension dysphonia and chronic laryngitis. Speaking voices were rated predominantly as "moderate deviation" on GRBAS (Grade, Rough, Breathy, Asthenia, and Strain). Maximum phonation time ranged from 4 to 29 seconds (females: 10.2, standard deviation [SD]: 5.28 and males: 15.7, SD: 5.79). Singing frequency range was reduced (females: 21.3 Semitones and males: 23.99 Semitones). Dysphonia severity index (DSI) scores ranged from -3.5 to 4.91 (females: 0.075 and males: 0.64). Singing frequency range and DSI did not show significant difference between sex and across clinical diagnosis. Self-perception using voice disorder outcome profile revealed overall severity score of 5.1 (SD: 2.7). Findings are discussed from a clinical intervention perspective.
  
  
  CONCLUSIONS
  Study highlighted the nature of voice problems (hyperfunctional) and required modifications in assessment protocol for Carnatic singers. Need for regular assessments and vocal hygiene education to maintain good vocal health are emphasized as outcomes.
authors.affiliation: Department of Ear Nose Throat/Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India.
authors.forename: Ravikumar
authors.initials: R
authors.lastname: Arunachalam
authors.affiliation: Department of Speech, Language and Hearing Sciences, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India. Electronic address: praxb77@yahoo.com.
authors.forename: Prakash
authors.initials: P
authors.lastname: Boominathan
authors.affiliation: Department of Speech, Language and Hearing Sciences, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
authors.forename: Shenbagavalli
authors.initials: S
authors.lastname: Mahalingam
mesh_terms: D000162:Acoustics; D000293:Adolescent; D000328:Adult; D000368:Aged; D001307:Auditory Perception; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007194:India; D007827:Laryngitis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D010699:Phonation; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D063346:Singing; D013061:Speech Acoustics; D013068:Speech Production Measurement; D013066:Speech-Language Pathology / Q000379:methods; D049489:Stroboscopy; D062606:Tertiary Care Centers; D014741:Video Recording; D014832:Voice Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D014833:Voice Quality; D055815:Young Adult
keywords: Carnatic singing; Indian singing; Singing frequency range; Vocal hyperfunction; Voice analysis