Most classical singers have at one time in their lives performed in choirs, if only in high school and college, or perhaps in the form of a weekend church gig. Choirs vary in size, makeup, and ability, and their repertoire also ranges from modest songs written for personal pleasure to the massive concert works of the Baroque and Classical eras. In keeping with the season, I thought it might be appropriate to look at some medical issues I have seen among choral singers.
For the past 20 years I have been affiliated with the Westminster Choir College in Princeton, N.J., and had the privilege of associating with one of the world’s finest concert choirs. Most of my choral singing patients, however, are kids from high school and avid amateurs who sing for fun.
One problem among younger singers is inadequate training. They join the high school choir because they love music and have some talent, but they may lack technique. Their voice teaching often consists of nothing more than general group instruction by the choir master, certainly not individual lessons on technical issues. These young singers then sing with excess strain, resulting in an elevated larynx, tight throat, and eventually muscle tension dysphonia, even nodules. They never sing to a teacher alone, and the technical issues are not picked up and corrected.
Other factors conspire to make things worse. Often young choral singers are singing in the wrong Fach. A 14-year-old future soprano may be asked to fill in as an alto, because there aren’t enough altos in Grade 8 that year. She will then get stuck in that role, never developing her high extension. As young singers change anatomically, the voice may also change, so even someone who was correctly placed initially may outgrow that Fach, and fail to be noticed and reassigned in the chorus.
A problem that is common to all choirs, even the most accomplished professional ones, is that the singer cannot adequately hear her own voice. We normally monitor our vocal output in several ways: hearing the sound around us, perceiving bone-conducted sound through the skull, and feeling mechanical vibration in the chest and head. The first, and arguably most important of these, is taken away in choral singing. Each singer hears the two singers on either side, as well as the one standing behind, but not her own voice!
Like flying blind, the choral vocalist is singing deaf. This leads to a dependence on monitoring the voice by proprioception, and a tendency to oversing. A further abettor of oversinging is the well-intentioned choir master, conducting and prompting with exaggerated articulation and gesticulations, and desperate to get things to sound right in time for the holiday school concert, which is only two weeks away! These form a distraction in terms of a singer who is trying to focus on internal real-time monitoring of the sound she makes. Under such circumstances, even well-trained singers will often oversing and develop laryngeal strain.
A less frequent issue, but one I have occasionally dealt with, is the sheer volume of sound a choral singer’s ears must endure. I’ve never measured the sound intensity heard by a singer standing in the middle of a chorus, but I suspect the decibel level is much higher than what is heard on an opera stage. And it is unremitting. I have seen a number of singers over the years with tinnitus (ringing in the ears) or increased sound sensitivity from excess noise.
This condition is well known among orchestral musicians (the classic anecdote of the violinist with a deafened ear who has sat in front of the piccolo player for the last 25 years). In some such cases, I have recommended to patients that they try musicians’ earplugs, or at least position themselves at the end of a row, so their damaged ear gets a break. (Musicians’ earplugs are custom plugs with a noise filter that cuts sound equally across all frequencies. This means that the sound does not become muffled, due to excess decrease in high frequencies, but remains true across the frequency range, just decreased by 15 or 25 decibels.)
A final, and by comparison rather mundane, issue is the increased exposure to upper respiratory infections. Even if the baritone behind you is not coughing, the mere act of singing can spray saliva laden with bugs into the air. Choral singers, huddled closely together on stage, place themselves well within the trajectory of such bugs traveling “on the wings of song.” So choral singers, especially during the cold and flu season, need to take extra precautions to avoid becoming infected.
But, to finish with a coda in a major key, good choral singing is one of the great glories of mankind. May it continue to thrive!
