title: The influence of vocal fold mass lesions on the passaggio region of professional singers.
abstract: In professional classical singing, an even voice quality throughout the entire singing voice range is essential. Transitions between vocal registers (passaggio) are the technically most challenging aspects in classical singing. It is hypothesized that they are most affected by vocal fold mass lesions (VFML).
  
  
  
  Cohort study.
  
  
  
  In this study, the effect of VFML on vocal fold vibration in the passaggio regions was analyzed in four female and three male singers suffering from organic dysphonia. The singers were asked to sing an ascending glissando through the passaggio regions, before and after treatment. The vocal fold vibration was documented with transnasal endoscopic high-speed imaging recordings at 20,000 frames per second, supplemented by synchronized acoustic and electroglottographic recordings.
  
  
  
  Major irregularities were found in the passaggio region of four singers before treatment, whereas the respective phonations below the passaggio were almost regular. In two female singers only the upper, but not the lower passaggio was affected. In all four of these participants, the passaggio region was more regular after treatment. In the remaining three participants, the VFML showed no effect on the passaggio region. However, the singers' ability to reach higher pitches was impaired, but was resolved after treatment.
  
  
  
  The data in this case study strongly suggest that the passaggio region could be affected by VFML, even if phonation outside the passaggio regions is unimpaired. When planning surgical procedures for professional singers, clinical examination protocols should therefore include phonatory tests across the passaggio regions.
  
  
  
  4 Laryngoscope, 127:1392-1401, 2017.
authors.affiliation: Institute of Musicians' Medicine, Freiburg University Medical Center, Freiburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Echternach
authors.affiliation: Institute of Musicians' Medicine, Freiburg University Medical Center, Freiburg, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Burk
authors.affiliation: Division of Radiology, Department of Medical Physics, Freiburg University Medical Center, Freiburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Burdumy
authors.affiliation: Laboratory of Bio-Acoustics, Department of Cognitive Biology, University of Vienna, Vienna, Austria.
authors.forename: Christian T
authors.initials: CT
authors.lastname: Herbst
authors.affiliation: Institute of Musicians' Medicine, Freiburg University Medical Center, Freiburg, Germany.
authors.forename: Marie
authors.initials: M
authors.lastname: Köberlein
authors.affiliation: Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Erlangen Medical School, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Döllinger
authors.affiliation: Institute of Musicians' Medicine, Freiburg University Medical Center, Freiburg, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Richter
mesh_terms: D000328:Adult; D055154:Dysphonia / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010699:Phonation / Q000502:physiology; D063346:Singing / Q000502:physiology*; D014827:Vocal Cords / Q000503:physiopathology*; D014833:Voice Quality / Q000502:physiology*
keywords: Singers; high-speed digital imaging; vocal fold mass lesions