title: Dysphonia in performers: toward a clinical definition of laryngology of the performing voice.
abstract: OBJECTIVE
  To identify causes of dysphonia in performers and compare causes and aspects of treatment of dysphonia in performers and nonperformers.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  A chart review of all new patients presenting with a chief complaint of dysphonia over a 1-year period was performed. The prevalence of laryngeal disorders was reviewed and differences between performers and nonperformers were analyzed. The odds ratio of the prevalence of each disorder was computed against performer status as a risk factor.
  
  
  RESULTS
  Four hundred seventy-six new patients complaining of dysphonia presented over 12 months; 74 were vocal performers. The median duration of symptoms in performers was 90 days. Phonotraumatic lesions were significantly more prevalent in performers (63.5% vs. 28.6%, P < 0.001), particularly bilateral mid-fold swelling (4-fold increase in performers), pseudocysts (3-fold increase), and vocal fold hemorrhage/ectasia. Neurologic disorders (vocal fold paralysis and spasmodic dysphonia), neoplastic pathologies, and age-related phenomena (atrophy/presbyphonia) were significantly more common in nonperformers. Overall and diagnosis-specific rates of surgical intervention were equal between the two groups.
  
  
  CONCLUSIONS
  Phonotraumatic injury is responsible for the majority of dysphonia in vocal performers, to a significantly greater extent than in nonperformers and requires the implementation of standard therapeutic strategies. Awareness of the specific risks and management needs of the performer is of paramount importance to the practice of laryngology of the performing voice.
authors: Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Walnut Creek, California.
authors: Joel
authors: J
authors: Guss
authors: Department of Otolaryngology-Head and Neck Surgery, Beth Israel Medical Center, New York, New York.
authors: Babak
authors: B
authors: Sadoughi
authors: Voice Center, Hackensack University Medical Center, Hackensack, New Jersey.
authors: Brian
authors: B
authors: Benson
authors: Sean Parker Institute for Voice Disorders, Department of Otolaryngology, Weill Cornell Medical College, New York, New York. Electronic address: lus2005@med.cornell.edu.
authors: Lucian
authors: L
authors: Sulica
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D055154:Dysphonia / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D007830:Larynx / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009146:Music; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D016272:Occupational Health; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D063346:Singing; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors; D014741:Video Recording; D014833:Voice Quality; D055815:Young Adult
keywords: Dysphonia; Performing voice; Phonotrauma