. ' - THE EFFECTOFCHEERLEAD'N ' .. ,j i" . _ .1 w , 5:;IssertatlonfortheDegreeDfPh .35 *1». :_ A TM'CHI ‘N'SIAT—BUNN.‘ d"; PAULEBRAVENDER “r~,.‘ w-I'" 3 293 10607 96 This is to certify that the thesis entitled THE EFFECT OF CHEERLEADING ON THE FEMALE SINGING VOICE presented by Paul E. Bravender has been accepted towards fulfillment of the requirements for Ph.D. Music degree in Major essor Date February 1, 1977 0-7639 ABSTRACT THE EFFECT OF CHEERLEADING ON THE FEMALE SINGING VOICE BY Paul Eugene Bravender The problem of this study is to determine whether or not participation in cheerleading activities inhibits the natural function of the female singing voice. Experimental Design To provide the necessary information for the solution of the problem the following experiment was designed: 1. Samples of voice recordings of female sub- jects who have been cheerleaders for a minimum of three years. 2. Samples of voice recordings of female subjects who have never been cheerleaders, i.e., a con— trol group. 3. A panel of auditors who are experts in the field of vocal sound production. This panel will be asked to identify those subjects exhibiting any degree of vocal dysfunction. Paul Eugene Bravender In all, twenty—three cheerleaders and twenty-four control group members were recorded. For various reasons, such as the inability of subjects to perform musical scales, or poor recordings, only nineteen subjects from each group were used. Each subject sang an ascending scale, starting on A (220 Hz) and ascending as high as possible; and a descending scale, again starting on A (220 Hz) and going to the lower limit of the range. Ixtaperecordingof these samples was prepared for auditors. The auditors were given score sheets which gave them the opportunity to evaluate each subject in the following ways: 1. A written musical scale, upon which each auditor was to indicate the pitch level at which any register change took place. 2. A numerical scale, (0 = none, 1 = slight, 2 = moderate, 3 = severe) within which the auditors were asked to indicate the degree of damage or dysfunction observed. The following data were obtained: 1. Forty-two percent of the cheerleading group exhibited a moderate-to-severe level of dysfunction (2.0), while only five percent of the control group were found at this level. 2. The cheerleading group has a composite score more than twice that of the control group, (1.5 vs. 0.7) Paul Eugene Bravender indicating a significantly higher level of vocal dys- function among the cheerleaders as a group. Based on the accumulated data the following con- clusions can be drawn: 1. Long term (three years or more) participation in cheerleading results in a statistically higher inci- dence of severe dysfunction in the female voice, as mani- fest in a high degree of hoarseness and the inability to phonate throughout the full compass of the normal female voice range. 2. Long term participation in cheerleading results in a statistically higher incidence of loss of vocal clarity, even if less than severely dysfunctional. 3. Because of the conclusions above, and within the limits of this study, females who are interested in using their voices for singing should refrain from cheer— leading. 4. No conclusions could be reached regarding pitch level of register change in cheerleading subjects. THE EFFECT OF CHEERLEADING ON THE FEMALE SINGING VOICE BY (I. 0%?“ Paul E. Bravender A DISSERTATION I. Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Music 1977 Copyright © PAUL EUGENE BRAVENDER 1977 ACKNOWLEDGMENTS I am very grateful for the assistance of the many people who contributed to the completion of this study. Special thanks must be given to Dr. J. Loren Jones of Michigan State University for his considerate guidanceeand counsel; to Dr. Gerald R. Moses and Mr. David Palmer of Eastern Michigan University for aid in establishing the statistical design and for setting parameters for measurement. I am especially grateful for the encouragement and support given by my wife, Constance, and my children, Robert and Ann. ii TABLE OF CONTENTS Page LIST OF FIGURES . . . . . . . . . . . . iV LIST OF APPENDICES . . . . . . . . . . . V Chapter I. INTRODUCTION . . . . . . . . . . . 1 Purpose . . . . . . . . . . . . 1 ” Problem . . . . . . . . . . . . l Terminology . . . . . . . . . . 1 Experimental Design . . . . . . . 2 Delimitations of the Study . . . . . . 3 Background of the Problem . . . . . . 3 II. RELATED RESEARCH . . . . . . . . . 9 Conclusions Concerning Related Research . . 15 III. METHODS AND PROCEDURES . . . . . . . l6 Selection of Subjects . . . . . . . . l6 Recording of Subjects . . . . . . . . l7 Selection of Auditors . . . . . . 18 Confirmation of Auditor Response . . . . 20 IV. PRESENTATION AND INTERPRETATION OF THE DATA . . . . . . . . . 22 V. CONCLUSIONS . . . . . . . . . . . 37 Recommendations for Further Studies . . . 38 APPENDICES . . . . . . . . . . . . . . 40 BIBLIOGRAPHY . . . . . . . . . . . . . 69 General References . . . . . . . . . 70 Figure 1. LIST OF FIGURES Auditor Response . . . . . . . Control Group . . . . . . . . Cheerleading Group . . . . . . . Degree of Dysfunction, Control Group . Degree of Dysfunction, Cheerleading Group Composite Degrees of Dysfunction, Cheerleading Group and Control Group Percent at or Above 2.0 Level (moderate to severe damage) and Percent at or Above 1.0 Level (minimal damage) . . Percent Below the 2. 0 Level (moderate damage) . . . . Percent Below the 1.0 Level (minimal damage) . . . . . . iv Page 24 26 27 29 30 31 33 34 35 LIST OF APPENDICES Appendix Page A. Instructions to Auditors . . . . . . . 41 B. Auditor Score Sheet . . . . . . . . 44 C. Statistical Analysis . . . . . . . . 46 D. Letter to Subjects . . . . . . . . . 51 E. Reports From Laryngologists . . . . . . 53 CHAPTER I INTRODUCTION Purpose The purpose of this study is to provide informa- tion concerning the effect of cheerleading upon the female singing voice. Problem The problem of this study is to determine whether or not participation in cheerleading activities inhibits the natural function of the female singing voice. Terminology Bernoulli Effect: Suction produced by the fact that air in motion has less density or pressure than air that is not in motion; its application in phonation is important in that the vocal bands can be drawn together to vibrate merely by the passage of air between them. Chest Voice: The lowest register of the human voice (called the "heavy Mechanism" by Vennard), characterized by a firm closing of the glottis for a relatively long period of time, allowing an almost explosive burst of air to be built up between successive openings of the glottis and creating a greater amplitude of vibration.2 lWilliam Vennard, SINGING, the Mechanism and the Technic, (New York: Carl Fischer, Inc., 1968), p. 42. 2 Ibid. Contact Ulcer: An open lesion produced by friction between the arytenoid cartilages. Common among men who abuse their voices. Rare among women. Phonation: The act of producing vocal sound by the adduction of the vocal folds simultaneously with the expiration of air form the lungs. Vocal Dysfunction: Any condition which interferes with the efficiency of phonation, manifested in abnormalities of vocal clarity, range, and point of transition from chest voice. Vocal Nodules: A general term encompassing a large variety of benign growths on a vocal fold, usually occurring at the junction of the anterior and middle third of one or both folds, edematous in early stages and progressing to a fibrous state. They are the result of vocal trauma, and are a virtual anathema to clear vocal production in speaking or singing. Common among women who abuse their voices. Experimental Design To provide the necessary information for the solu- tion of the problem the following experiment was designed: 1. Collect samples of voice recordings of female subjects who have been cheerleaders. 2. Collect samples of voice recordings of female subjects who have never been cheerleaders, i.e., a control group. 3. Establish a panel of auditors who are experts in the field of vocal sound production. This 31bid., p. 241. 4Henry J. Rubin, M.D., "The Role of the Laryn— gologist in Management of Dysfunction of the Singing Voice," NATS Bulletin, May, 1966, p. 24. panel will be asked to identify those subjects exhibit- ing any degree of vocal dysfunction. To execute the above design the following condi- tions will be necessary: 1. Recorded samples of voices must be provided to allow the panel of auditors to make objective compari- sons. It was decided that a musical scale starting on A (220 Hz.) and ascending to the highest tone possible for each subject would offer the following: a. samples of chest voice singing in the lower female range b. the range selected would be reasonable for all subjects 2. There must be established a statistical design which will reveal any possible correlation between cheerleading and the incidence of vocal dys— function. Delimitations of the Study Only female subjects will be used in this study. For the control group, only subjects who have not had formal vocal training will be used in order to protect the objectivity of the study. Background of the Problem It has been the experience of voice teachers that those female students who have been cheerleaders l frequently exhibit some degree of phonational diffi— culty. Hoarseness, limited range, and carrying the chest voice too high are but some of these symptoms. In some cases, visual examination of the vocal folds by an otolaryngologist has revealed actual physical damage to the vocal folds themselves, in the form of vocal nodules. The following citations will support this contention: Chest voice singing appears to be a normal and healthy use of the female voice unless it is carried upward to extremely high pitches or produced with too much force. Under such cir— cumstances it would not be surprising to find hoarseness caused by swollen vocal folds . . . Cheerleading falls in this latter category but with one additional observation. Early commit- ment to cheerleading is much more damaging to the female voice. The extreme force used in the shouting, pushing the chest voice upward to the extremely high pitches, has left many young girls with a set of atrophied vocal folds, usually considered permanent damage, or with vocal muscles which will not respond to certain pitches. Should you be testing female voices and discover one which cannot produce tones in the area of D, E, and F, just above third space C, you may discover a young lady who was a cheerleader. The normal "upper middle voice range" is most often the location of a break in the voice of young ladies who have yelled too loudly, on pitches too high, and who have become hoarse, often with laryngitis, too many times. Nature will not put up with such continued abuse.5 The following footnote was appended to this article by the Editor, Louis H. Diercks: "Cheerleading, 5J. Loren Jones, "What Happens in Singing," The Choral Journal, May 1975, p. 6. particularly for girls has been found the cause of nodules on the larynx to an alarming extent."6 An examination of the literature in the field of cheerleading has revealed but two works: Cheerleading by Newt Loken, and Cheerleading, Pep Clubs and Baton Twirling, by Stella S. Gilb. The information contained relating to the proper use of the voice is meager. The following citation from the Loken text is the only instruction in either book concerning proper vocal technique: A good method of improving the cheering or yelling techniques is to place a hand on your abdomen and yell "fight." The sound should originate from the stomach. You should feel the tightening of the adbominal muscles when yelling. In another suggestion concerning how a voice may be protected (which supports the claim that cheer- leading is abusive to the voice), Loken suggests "soundlessly moving the lips" when the voice is not in good condition.8 No references were found concerning the subject of phonation. Without proper phonation, the efficiency of breath support which Loken describes could, in itself, 61bid. 7Newt Loken, Cheerleading, (New York: The Ronald Press Company, 1961), p. 12 8Loken, op. cit., p. 12. be detrimental to good vocal health. Vennard's compari- son between plosive phonation and that which utilizes the Bernoulli Effect will serve to illustrate the ulti- mate source of the problem: This is how vibration is initiated by the aspirate [h]. Breath is flowing while the glottis is closing by action of the interary— tenoid muscles. When the vocal muscles are nearly enough together, the Bernoulli Effect sucks them into vibration before the carti- lages have approximated (it may even be an imperfect approximation...thessequenceof aero- dynamic factors is as follows: first the flow of breath sucks the glottis shut; this stops the flow momentarily, whereupon breath pressure blows the glottis open again: air flow recom- mences and the cycle repeats. The Glottal Plosive: If the glottis closes first, and then breath pressure is applied, the vibration will begin with an explosion of air as the pressure overcomes the muscular tension. The Bernoulli Effect will then become a part of the process, it is true, but too late. The muscular adjustment is not the same . . . . Friction is thus created between the vocal pro— cesses as the cartilages are further drawn together, and sometimes repeated glottal plo- sives actually produce contact ulcers between the cartilages . . . . The glottal plosive is really a slight cough. The whole larynx tenses for it. The explosion is one which laryngologists agree is damaging to the deli- cate structures. 0 According to Vennard, then, cheerleaders should avoid the heavy glottal plosive and utilize a phona- tional adjustment which would depend on the Bernoulli Effect. The question then arises concerning the degree 9Vennard, op. cit., p. 42. lOVennard, op. cit., p. 42. of difficulty involved in acquiring such skill. Singers, for example, devote a large amount of time concentrating on proper phonation. Many teachers believe that it is the very cornerstone of a healthy singing technique. During the course of this investigation no evidence has been found to suggest that cheerleaders receive any training in developing healthy phonational technique. The problem is compounded by the fact that cheerleaders' activities are not limited to partici— pation in once-a-week athletic contests. Many cheer- leading squads have regular practice sessions previous to and following the athletic event. This does two things: it contributes to vocal fatigue, and it does not allow vocal rest. The problem of excessive demand on the voice has been recognized by Gilb, who suggests: When an emergency arises, such as getting ready to cheer for the first football game, I would suggest as many practice sessions as it is possible to have. As the season progresses, so do the cheerleaders, and the number of prac- tices may be lessened. Three a week may be necessary when the members of the cheerleading group are beginners; however, two a week is the recommended number. Gilb does not, however, suggest that the reason for limiting practice sessions is the protection of the voice. In discussing the length of the practice llStella S. Gilb, Cheerleading, Pep Clubs and Baton Twirling (Lexington, Ky: Hurst Printing Co., 1955), P. 36. session Gilb states, "anything less than an hour appears to be a waste of time."12 A valid question may be raised as to whether vocal dysfunction is a result of the cheerleading activity or whether it existed prior to participation in the activity. However, this question can be answered by the realization of the fact that one of the criteria for the selection of cheerleaders is vocal quality: "Cheerleaders should have a clear, commanding voice."13 In summary, singers are trained in proper phona- tional techniques, while cheerleaders are not; the burden of practice sessions and performances at athletic contests with incorrect phonation leads to vocal trauma. Personal experiences, the experience of many other voice teachers, and research which shows little or no know- ledge of proper vocal techniques on the part of cheer- leading coaches indicate that sufficient evidence exists to acknowledge the presence of a significant problem in the direct correlation of cheerleading and vocal dysfunction. An examination of Thesis Abstracts from 1872 to the present reveals no other research in the area of cheerleading as a possible cause of vocal dysfunction. lZIbid., p. 37. l3Loken, op. cit., p. 12. CHAPTER II RELATED RESEARCH Although an examination of available literature has failed to reveal any research specifically correlat— ing cheerleading and vocal dysfunction, a number of works have been published reporting phonational dysfunction as a result of vocal hyperfunction; i.e., the kind of vocal abuse which may occur through participation in cheerlead— ing. The reports examined are from the disciplines of Laryngeal Pathology and Speech Pathology. As such they are primarily concerned with the function of the speaking voice. All are in agreement with the basic tenet that vocal dysfunction is primarily a result of vocal abuse. The following citations will serve to illustrate the general accordance with this hypothesis. In a paper reporting on the incidence of vocal nodules in children, Wilson supplies an excellent definition of vocal abuse: Vocal abuse may be defined as the improper use of the voice as a result of too high pitch, exces- sive air pressure against the under surfaces of the bands, excessive talking and prolonged vigorous 10 use of the voice such as screaming, (and) shouting . . .1 In the above definition, every item suggested is a factor in cheerleading, with the exception of excessive talking. Margaret C. L. Greene, Speech Therapist at Stoke Mandeville Hospital in England, in commenting on the relative importance of such vocal abuse states: “Dysphonia can be caused by structural abnormalities, disease, purely psychological disturbance, or faulty habits of voice production; the majority of voice dis- orders fall into the latter category."2 Greene goes on to explain the sequence of events that occur in the development of one kind of dysfunction: A strained voice is always the result of faulty voice production. The over—exertion of the intrinsic laryngeal muscles while speaking, singing or shouting results in permanent muscular strain which impairs the delicate precision necessary to the movements of the vocal cords in phonation. The thyroarytenoid muscles may only lack tone and appear flabby in appearance, but in severe cases of strain they may remain permanently bowed. This internal tensor weak— ness produces either breathiness of voice or cracking due to abrupt changes in pitch. The difficulty in phonation is accompanied by a natural impulse to force the voice, thus pro- ducing mounting muscular tension . . . As lD. Kenneth Wilson, Ph.D., "Children with Vocal Nodules," Journal of Speech and Hearing Disorders, February 1961, Vol. 26, No. l, p. 19. 2Margaret C. L. Greene, The Voice and Its Dis- orders, (New York: The MacMillan Company, 1959), p. 67. 11 greater effort is used, the extrinsic muscles of the larynx may become involved, the voice becoming harsh and strident, yet breaking easily, with the false cords pressing down upon the true cords which offer increased resistance to breath pressure by the strength of their adduction. At the same time the voice is forced well above its normal pitch. In such cases the delicate membranous coating of the larynx may become sensitive and the focus of infection by micro—organisms. Chronic laryngitis and sore throats are fre- quently the result of bad habits of voice pro- duction. When the movements of the cords are hindered by laryngitis the activity of the ventricular bands becomes greater and in con- tinual straining to produce the voice these may eventually participate in phonation . . . Such a voice is excruciating to hear and to produce.3 This vocal strain may take on other aural mani- festations, such as breathiness, as described by Greene: If the vocal cords are insufficiently tensed by the action of the thyroarytenoid muscles or adducted by the transverse arytenoid, a certain amount of unvibrated air is allowed to escape through them. The voice produced lacks volume and resonance and is weak or asthenic, breathy and husky. This type of voice is sometimes called paretic but this is an unsuitable term since the vocal muscles are not affected with paresis (slight paralysis). If their movements are impaired as a result of vocal abuse, the weak and breathy voice is one of the many symptoms of vocal strain described above.4 If the vocal strain is allowed to go uncorrected, vocal nodules may develop. Again, quoting Greene: The nodules which form on the outer edge of the cords and cause severe disphonia are 3Greene, op. cit., p. 68. 4Ibid., p. 75. 12 the direct outcome of vocal abuse and the indi- vidual's habitual method of forcing the voice. Vocal nodules, therefore can be regarded as an advanced stage in vocal strain. In addition to the citations mentioned above are those works which report specifically on vocal nodules and other functional disorders. The citations given below indicate the uniformity of medical opinion regard— ing such vocal abuse. In 1962 Dr. Godfrey E. Arnold, M.D., published a paper dealing with vocal nodules, in which he stated: After a great number of theories had been proposed to explain the cause of vocal nodules and polyps, it is now generally understood that these pathologic new growths are the mechanical result of faulty or excessive vocal use. They may be likened to callouses on the hands or corns on the toes which are caused by mechanical pres- sure from tools or tight shoes. Many authors agree on the direct mechanical cause by hyper- kinetic movements of phonation. Other descriptions of activities leading to vocal difficulties might also serve as definitions of the demands placed upon cheerleaders. Brodnitz states quite clearly: Some of the factors that combine to produce the pattern of vocal hyperfunction are . . abuse of the voice in work that involves shouting 5Ibid., p. 78. 6Godfrey E. Arnold, M.D., "Vocal nodules and polyps: laryngeal tissue reaction to habitual hyper- kinectic disphonia," Journal of Speech and Hearing Disorders, August 1962, Vol. 27, No. 3, p. 205. 13 or speaking with excessive loudness, faulty voice production . . . a range that exceeds the natural limits.7 Greene states that "Vocal strain occurs most frequently in those whose occupations make severe demands upon the voice."8 The criteria for the selection of cheerleaders may actually predetermine the onset of vocal difficulties. According to Loken, cheerleaders "must be full of pep, vibrant . . . ."9 Cheerleaders are also frequently selected on the basis of athletic talent. Arnold has found that these two factors alone can be predisposing factors to the formation of phonational difficulties: According to clinical experience, these tissue reactions to chronic irritation are seen mostly in persons of pyknic or athletic body type. A second predisposing factor is seen in the psychosomatic constitution or personality structure. Numerous authors have remarked on the general observation that nodules and polyps are seen mostly in voceriferous and aggressive personalities . . . This author has repeatedly drawn attention to the fact that hyperkinetic disphonia is regu— larly associated with the sthenic type of pyknic or athletic body build. 7Friedrich S. Brodnitz, M.D., "Vocal rehabilita- tion in benign lesions of the vocal cords," Journal of Speech and Hearing Disorders, February, 1958, Vol. 27, No. 4, p. 113. 8Greene, op. cit., p. 69. 9Loken, op. cit., p. 12. 14 Thus we find the circle closed by the follow— ing correlation. Hypertrophic reaction of hyper- plastic mucosa in the muscular body type is asso- ciated with aggressively hyperkinetic movements of phonation and a tendency to formation of vocal nodules or polyps. The following citation by Greene offers a concise statement of the conditions under discussion: Constant shouting obviously imposes a strain upon the voice. The trained speaker or singer can produce a considerably louder voice when performing in a theater than the average person when shouting, but the trained voice suffers no injury because it is properly produced.11 This lack of proper training in phonational techniques on the part of cheerleaders is of prime importance. As Wilson states: West, Ansberry and Carr maintain that if the voice is properly used, no amount of vigorous vocalization can damage the edges of the vocal cords. Wells states that friction and impact seem to cause the nodules . . . Berry and Eisenson estimate that vocal abuse probably accounts for the development of the granuloma in 90 per cent of the cases.12 The works here cited are not intended to be an exhaustive presentation of all forms of vocal abuse. The purpose of including these references is, however, sufficient to indicate the relationship between vocal strain and vocal nodules and to present a representative 10Arnold, op. cit, p. 206. 11Greene, op. cit., p. 69. 12Wilson, op. cit., p. 19. 15 group of citations showing the uniformity of expert opinion regarding the definition, cause, and results of vocal abuse. Both Loken and Gilb speak of the acti- vity of the cheerleader totally in terms of "yells." The cheerleader's main function would seem to involve a great deal of activity which, as is defined in the citations above, constitutes vocal abuse. Conclusions Concerning Related Research 1. Vocal abuse has two separate and distinct characteristics: a. overuse, in terms of duration, force, and range b. faulty techniques of production Vocal abuse frequently leads to vocal dys- function, especially when both character- istics are present simultaneously. This dysfunction can take one of several forms: a. vocal strain b. permanent muscular atrophy c. vocal nodules Cheerleading encourages vocal abuse. CHAPTER III METHODS AND PROCEDURES Selection of Subjects The criteria for selecting subjects are as follows:» members 1. The a minimum of three years participation in cheerleading no formal vocal training presently or recently involved in cheer— leading following criteria were established for of the control group: 1. no participation in cheerleading no formal vocal training ages compatible with those of the cheer- leading subjects subjects were contacted through: interviews with cheerleading coaches and other high school personnel advertisement in the Eastern Echo, the student newspaper at Eastern Michigan University personal references 16 l7 Recording of Subjects The cheerleading subjects were recorded "in the field," i.e., at the various high schools represented, and in voice studios at Eastern Michigan University and Michigan State University. Subjects were given a prac— tice session prior to having their voices recorded. The sessions were approximately fifteen minutes in length. The control group members were recorded at Eastern Michigan University. In all, twenty—three cheerleaders and twenty- four control group subjects were recorded. Three of the cheerleaders and four of the control group were unable to match pitch and were eliminated from the study. One of the samples from the cheerleading group was eliminated because of a malfunction in recording equipment, giving a total of nineteen acceptable samples of cheerleaders' voices,and twenty of control group members. One control sample was eliminated by random choice to give an equal number of samples for comparison. The samples were then numbered one through nineteen for cheerleaders, and twenty through thirty-eight for control samples. They were then arranged on a master tape recording in random sequence. This tape was then edited and copied to pro— duce another master tape, on which each sample was announced by number. Each sample was repeated. The auditors had no way of knowing whether they were 18 listening to a sample of a cheerleader or a control group number. All subjects sang an ascending scale, starting on A (220 Hz.) and ascending as high as possible, and a descending scale, again starting on A (220 Hz.) and going to the lower limit of the range. Selection of Auditors It was determined that the panel of auditors would include not only experienced voice teachers but also experts in speech pathology. The following persons consented to serve as auditors: 1. Dr. Leo Deal, Ph.D., Chairman of the Depart- ment of Audiology and Speech Sciences, Michigan State University; 2. Ms. Carol Haynes, Clinical Supervisor of Speech Pathology, Michigan State University, (Certificate of Clinical Competence of the American Speech and Hear- ing Association); 3. Ms. Carolyn M. Hagey, third year doctoral student in Speech Pathology at Michigan State University; 4. Dr. J. Loren Jones, D. Mus. Ed., a member of the voice staff at Michigan State University, a voice teacher and performer of many years' experience; 5. Mr. Gean Greenwell, Past President of the National Association of Teachers of Singing, retired Chairman of the Voice area at Michigan State University, l9 voice teacher and performer of great experience, former member of the New York City Opera Company; 6. Mrs. Leona Witter, member of the voice staff at Michigan State University, teacher and performer of many years' experience, and a former member of the New York City Center Opera Company; 7. Mr. Ernest Brandon, member of the voice staff of Eastern Michigan University, Master's Degree in Voice from the University of Illinois; 8. Ms. Veronica August, member of the voice staff at Eastern Michigan University, Master's Degree in Voice from Indiana University. At each of the hearings, the auditors were given score sheets which provided the following vehicles for evaluation:1 1. a chart of the musical scale for the auditors to indicate the pitch level at which any regis- ter changes took place, 2. a numerical scale, (0 = none, 1 = slight, 2 = moderate, 3 = severe) within which the auditors were asked to indicate, by circling the appropriate number, the degree of damage or dysfunction observed, 3. a space for individual comments. Each audi- tor was also given written instructions covering the use of the score sheet. 1See Appendix for sample score sheets. 20 Pretraining of the auditors was accomplished by playing two "trial" samples, one of which was judged to be a normal, undamaged voice (to be graded "0," or no damage), and one which was judged to be a severely damaged voice (to be graded "3"). The preceding para- meters were determined with the assistance of Mr. David Palmer, Speech Pathologist at Eastern Michigan University. The auditors were instructed to utilize two unused sam— ple reporting spaces to practice using the grading sheet; they were also instructed not to discuss their individual opinions throughout the hearing. The equipment used for this project was the Sony stereophonic tape recorder, model number TC 252. This machine has a power of 45 watts, a frequency response of 30—18,000 Hz at 7 1/2 ips, and a signal to noise ratio of 50 dB. The tape copying was done through direct line to an identical machine; the tape was played for the auditors on the same machine on which the samples were originally recorded. Confirmation of Auditor Response Sample numbers 22 and 28 were played again as sample numbers 39 and 40. This was done without the knowledge of the auditors, as a means of checking con— sistency of auditor response. In each instance, there 21 was no variation of response from any auditor. Consis— tency was unanimous. The mean score for each subject was determined. The standard "t" test for independent means was applied to the findings of the auditors to eliminate the chance factor: t = X1 - X2 s2 + a2 N1 N2 A 3 score of 3.64 was obtained, indicating a difference beyond the .01 level of confidence. This difference in the performance of the two groups (cheer— leaders and control group) would occur by chance less than one time in a hundred. Therefore, there is a true difference in the performance of the groups. Specifically, the auditors judged the cheerleaders' voices to be significantly (noticeably——to their ears) more damaged than those of the non-cheerleaders. CHAPTER IV PRESENTATION AND INTERPRETATION OF THE DATA This study was designed to examine two specific kinds of data of differing significance: 1. Primarily, to determine whether or not participation in cheerleading activity on a long term basis is damaging to the female voice. 2. Secondarily, to determine whether or not the register change out of chest voice is altered due to cheerleading. The results of the tests for register change were inconclusive for the following reasons: 1. A surprising number of subjects sang the entire exercise in only one register. Some sang the entire range in chest voice register, while others sang completely in head voice. No change of register occurred in these samples. 2. Due to different pedagogical and professional backgrounds, some of the auditors were unable to dis- tinguish register changes. Because of this, there was a lack of consensus concerning the exact pitch level for this change. 22 23 3. Under existing conditions the change of regis- ter was too subtle to be instantly recognizable. 4. In some cases, the condition of the subjects' voices was unclear. This precluded the possibility of determining in which register she was singing. It was hoped that it would be possible to draw some correlation between the pitch level of register change and participation in cheerleading, but no such conclusion can be made, based on this study. However, it was possible to draw some conclusions regarding the correlation between the degree of vocal damage or dys— function and participation in cheerleading activities, as the following graphic representations will show. Figure 1 shows how each auditor judged each subject, in terms of vocal dysfunction, on a scale of 0 - 3; also included is the mean score for each subject. (The circled figures represent the scores of the cheer— leading group.) Figure 2 shows the results of only the control group; Figure 3 represents the same information regarding the cheerleading group. In both instances composite scores of each group are included. omMHo>< oopomum um5m5¢ Haozcoouw 24 Hanna: wocmmm mommm Homo mOCOb Honfisz onEmm 10 ll 15 16 Figure 1.--Auditor Response. N U'I Sample Number o Greenwell o Witter H August m Brandon Average U] o a o b l H Deal 0 Hagey N Haynes O |-‘ O U1 Note: As a means of checking auditor consistency, sample number 22 was replayed as sample number 39; sample number 28 was replayed as sample number 40. This was done’with- out the'auditors' knowledge. Figure l.——Continued. N Ch r-i H (D G <1) 0 H m H 3 H o m HQ) U) >1 0) (D G U) ’U to Q: 0) H O) C} +1 (D :3 G H tag a m m m- w o o m m (U 0 (D (d (U H H 53 H > (DZ '1 Q B: m 3 (9 <22 m I< l l 1 0 l 2 0 0 0 0.6 2 O 0 . 0 0 0 0.2 _____ 3 1 0 0 0 0.4 4 0 2 l 2 l 0 l l 1.0 )____ 5 l l .5 l l 0 l 1 0.8 6 l 5 l 0 l 0 0 0 2 0 7 7 l l 0 l 0 0 2 0.7 8 l 3 l 0 0 0 0 O 0.6 9 3 3 3 3 3 3 3 3 3.0 10 0 1 0 0 0 0 0 2 0.4 —_.A ll 1 1 0 l O O 0 l 0.5 12 l 0 0 l O 0 0 0 0.3 13 1 1 0 0 0 0 0 O 0.3 ——4 14 l 1 0 l 0 0 l l 0.6 15 2 l l 2 0 0 l O 0.9 16 .5 1 0 0 0 0 0 O 0.2 r———- 17 1.5 2 2 l O 0 2 l 1.2 18 2 3 2 l 1 0 l 2 1.5 19 0 0 O 0 0 0 0 0 0.0 Composite Score 0.7 * Note: Since the last control group sample from Figure l is a repetition of an earlier sample, it is not included here in the computation of the composite score. Figure 2.——Control Group. 27 H H o a o m H m n 3 p o a rim m a o o c m U m m o H o a u w 5 c H fig C: (U 6‘ >1 4J <1) 0‘: a: (D m o o m m -H H 5 H > (DZ "3 Q :33 E: 3 {3 K1} in Ki} 1 2 3 l 2 l 0 0 2 1.4 2 3 3 3 3 3 3.0 3 0 0 l 0 0 0 0 0 1 4 2 3 3 3 2 2 3 2.6 5 2 1 2 3 0 0 l 2 1.4 6 2 1 2 2 0 0 0 3 1.3 7 3 3 3 3 1 O 2 3 2.3 8 0 0 2 0 0 0 0 2 0.5 9 2 2 2 5 2 2 3 2 2 2 2 10 l 2 1 0 0 0 l 2 0.9 11 1 l 0 2 0 0 l 2 0.9 12 l l 1 1 0 O 1 l 0 8 13 2 l 0 1 0 l 0 1 0.9 14 0 0 0 O 0 0 0 0 0 0 15 3 3 3 3 3 3 3 3 3 0 16 3 3 3 3 3 3 3 3 3 0 17 0 1 0 0 0 0 0 1 0 3 18 2 3 3 3 l 0 2 2 2.0 19 2 3 3 3 3 0 1 l 2.0 Composite Score 1.5 * Note: Again, as in Figure 2, only the first 19 samples were used to compute the composite score. Figure 3.--Cheerleading Group. of damage, as Figures 4 and 5 show. (Figure 6 isvé‘ composite of Figures 4 and 5.) 29 . . . . . O . . . . . . . . . . . . . . MNNNNNNNNOJNv-PFPv-Fv-Fv-v-OOOOOOO uoraoungsfiq go aaxbeq 000 Sample # Figure 4.-Degree of Dysfunction, Control Group. 30 '— cocococoooooooooooooooo-ooo uoraoungsfiq go 881690 0 .0. 000 Sample # Figure 5.——Degree of Dysfunction, Cheerleading Group. 31 .msouu Houucoo cam msouw mcflwmoauoono .cofluoasmmho mo mooumoo mnemomfiooii.w oudmflm mnoho achusoo «I I It I I U 9.6.3 mcflcmoapwmso H II * oaaama uorqoungsfia ;o aarbaa- 32 A significant comparison can be drawn between Figures 4 and 5. Only one of the control group samples (sample 9) lies at or above the moderate-to—severe level of dysfunction (2.0). This represents slightly more than 5% of the group. In the cheerleading group, however, eight of the samples lie within this range, representing slightly more than 42% of the group. Further, only 21%, or four samples of the control group can be found at or above the minimal range (1.0) of vocal dysfunction, while nearly 58%, or a majority of the cheerleading group is to be found in this range. Stated differently, fully 95% of the control group lies below the moderate level of dysfunction and 79% at or below the minimal level of dysfunction, while only 58% of the cheerleading group lies below the mod— erate level of dysfunction and only 42% lie below the minimal level. Figures 7 - 9 illustrate the above facts. 70 60 50 Percent 40 20 10 Figure . ...C .O.”’:& i33?”§§3 fittttttt 00000 .:B& 0 . :3’0030 o o . o 0.... 00%? Q. 009 :99 0 0 0 010.0 0.: '. 0 0:0? ' ‘z ' 00.0.9 0d§3i5 #000000 0 9i3§§§5 d ;3&&gg 0 O 0 ’0 t 0 f... .; ;. . O Q. .3 . 0_0_0 0 g ‘ 0 .. 0 .‘O 0 z 000’: 0 03 . ’%%%%%%%’ a 0.... . . .’%%"" we... m" ?§{{€€ §€€£ 0 00000 . .. 0 °%%%0 .3” O... ”.% ’ vvv 3’00 0' 0:50 . 0 0 00 0 ofifié};§i?'. {33foifi to 000:00 33;; ”an; 00 0%“ 00'. O: 00 5% ”:00 "bfi' ”fivgo ....'.C. O 5.... 00 S ’3’ O... 5”;0 0 v0 0 0c 0 fiflifl G '0 0% 00 ‘0 Ch Cheerlea ers Control Group 7.--Percent at or above 2.0 level (moderate to severe damage and percent at or above 1.0 level (minimal damage). 34 100. 0.... .4 $1020.03: - o °.°. o o'.’ .‘o‘o‘o’c o o o o o < 70- 50 Percent "In I ’I 9 o o o > o o . . . 3.59.... o o o o o. oIooIoIo p." 'm"Ic 9.0 0.... ° ’ oIo o o . .... . .. .:.° . . Cheerleaders Control Group Figure 8.--Percent below the 2.0 level (moderate damage). 0 0 . 0 0 0'0'0‘0 0000000000000, 0 00 0 0.0000. 0000 0.0.. 0 0 0000 0 0.0 000 000 0'0 0'0' 0 0 0 0 0 0'0. 0 0_0 0 0 00%”0 0 0000000000 0'0‘ 0 0 0.0.0:0:0:0:0:0.0:0' ' ’ 0 0 0 0 0 0 0 0 0' .A‘A.A 0 0 0 0 0 00 0 0.0 ’2 0.0 0.0 ‘0 0 0 0 0 0'0 5% 0 flu 0 0 0 0'0 .0 0 0 I). 000000 0 0.0000 0 0 O 0 0 0000 0 0 0 0 0 0'0'0‘0'0’0'0‘0 . 0 '0'0'0 0 0 0 0 0 0: 30:60.0 0 0.0.0.0 0 0 t I" “0.0.0.0 0 0 0 0 0 00 0 0 00 000000 000.0000000000000000000- 0000 ’a’ i .0 ’0 00 9;??? 00000 000000 .%%%%%%& 0 0000‘ 00000” 00 :0 000 0 0 .0 00.000000 0'00' 0.0 . 0 .0 0 0.0000000 v0 000 00000 000 000 0000 0000 0000 0000 %%%%0 0000000000 ' O 0 0'0'0 0 0 0 ”3° 1': 0 O '0 ’ 0 .0 000000 0 0 00 "v 0 0 0 0.30 0 .0. ”0. 0000000 "v 00 ’6 00 0 0000000 0‘0‘0'0'0‘0'0 0 0.0.0.0 0 0 0 0 0 0 0 0 O... 0.0 00 0000 v v I J J .0 0 :0 0.0. 0 v 0 000 3’0 00 0 0 .0 0 0 0.. O 0 50 0 0 00 0{ a '0 0 0 0 00 a 0 o a 0 fl 0 d 0 0 . 0 0 0 0 0 0 .0 0 0.0. 0.0. 0 0 00 ’0 Percent 0 0 .0 0 0 0 0 000. o 0. 0 0'0 0 0.0.0 0 0 00 0 0000 0:? 0010 000000 0 v v - 0:0.0z0 0 I 0S0 .0 0.0.0.3000 00% 0 0 To 00 0 ‘ S.:.0.00 0.0 . .0 u 0 0.0% 0.0.0.0.0‘0.0 ...... ....... ...... ....... ...... ....... ....... ....... ...... ....... ....... ....... ....... ....... ,...-.. «macaw? ”,%%~.. 0 'I 0 ¢ :0 .0 0 V .0 0 % I 000 .;.° 0 0 .;.;~ 50 0 a 00 .0 .0 $0 00 05$ 0 I .. ;.; 0 0 .‘o o 0 0 a 0 0 0 0 0 0 0 0 0 0 0 .L 0 0 .0 0 0 0 0 0 J .0 0.0 .0 0 0.0 0 0 0 0 0 0 0 0 .0 0 .0 '2 0 . 0 0:0 0% .0 0‘0 0 0.0 .0 0‘0 0 0 0 0 0 0 0 0 I 0 } 0 0.0 0 0 0.0 ’0‘ 0 0 00 .0 0 0 .1 0% 0.0 0 0 a i E 0. .0 '0 0 0 H 0 0 3 .0 a 000 0 030 .v a .0 0 .0 0 0 0 0 0 0 00 00 a’ t 0 0 0 0 V0 ‘ 0 0 v 0 ’ 0 vv 0 0 0 0 0 0 0 0 J 00 0 .k 0 .0 4 .0 0 5% I: ’0 ’0 ’0 0 0 0 0 0 0 0 .; {0 00 {e0 2.» 0 0 .0? 000 0 % 00 000000 0 0 0 0 0 '0' 00 0 00 '0; 0 0 0 fl 0 § 0 ’0 0 p 0 v 000 i; 0 20 0'0‘0'0 0 0 0 0 0.0 0.0. 0000 ’0’; .0_0,0 0 a Q 0 a 0 20 v 0 0 0 0 0 0 0 0 0 0 0 0 v 0 J 0 0 J 0 0 0 0 0 0 0 0 0 00 0 0% ’0 Cheerleaders Control Group Figure 9.—- Percent below 1.0 level (minimal damage). 36 Summary The data presented in this chapter have pro- vided information about the effect of cheerleading on the female voice, completing the experimental design as proposed in Chapter One. Nineteen subjects of both cheerleading and control groups were heard by eight expert auditors who rendered opinions regarding the degree of dysfunction in each voice and the pitch level of register change where possible. While the register change data proved inconclusive, the information about the degree of dysfunction, which was the primary con- cern of this study, is highly significant. On the basis of this information, the following chapter will be devoted to conclusions regarding the effect of pro- longed cheerleading activity on the female voice. CHAPTER V CONCLUSIONS Based on the data presented in the previous chapters the following conclusions can be drawn: 1. Long term (three years or more) participa- tion in cheerleading results in a statistically higher incidence of severe dysfunction in the female voice, as manifested in a high degree of hoarseness and the inability to phonate throughout the full compass of the normal female voice range. 2. Long term participation in cheerleading results in a statistically higher incidence of loss of vocal clarity, even if less than severely dysfunctional. Of the eight subjects who exhibited obvious vocal dysfunction (determined by the panel of expert auditors), four ultimately were medically examined at the Michigan State University Speech and Audiology Clinic by Dr. Y. Pal Kapur or by Dr. Roger W. Miller of Ypsilanti, Michigan. Four subjects with severe dysfunction did not appear for the medical examination. The results are as follows: 37 38 Subject #1: Nodules. Subject #2: Chronic laryngitis. Subject #3: Chronic laryngitis. Subject #4: Acute chronic laryngitis, evidence of physical damage to vocal cords ("both cords are thickened"). The implication of the above conclusions for any young female anticipating involvement in singing is obvious: cheerleading participation on a prolonged basis is contraindicated. Recommendations for Further Studies This study makes no determinations regarding the effects of cheerleading of less than three year's dura- tion; therefore, no conclusions can be reached concern- ing short term participation in cheerleading activities. There is a definite need for a study to determine the effect of short term participation in cheerleading; e.g., the effect of one year of participation, and a simi- lar study to show the effect of two years of participa— tion. A continuation and expansion of the present research, over a greater length of time and using a larger number of subjects, would be extremely valuable. Such a study should record subjects before any parti- cipation in cheerleading, after one year, after two 39 years, and again after three years, using the same evalua- tion methods as developed in this current project. The testing of a cheerleader‘s voice quality immediately before and after a football game and again several days later would also provide valuable informa- tion. Another current vocal practice which has many correlaries with cheerleading, and therefore deserves attention, is the effect of "rock" singing on the voice. All of the above proposed studies could be equally applied to the male voice. APPENDICES 40 APPENDIX A INSTRUCTIONS TO AUDITORS 41 INSTRUCTIONS EEZAUDITORS: You will hear recorded samples of both cheerleaders' and non- cheerleaders' voices in random order. Each subject will sing an ascending scale, starting on A (220 Hz.), and going upward to the limit of her range; then, again starting on A (220 Hz.), a descending scale, going downward to the limit of her range. In this manner you will hear the quality of each voice throughout its entire compass. You are asked to identify which of those samples exhibit signs of phonational disorders, manifest by lack of clarity, hoarseness, and/or by the inability to phonate throughout the normal voice range. You are also asked to quantify your observations by using the following scale: 0 = perfectly clear voice; no damage 1 = slight lack of clarity or hoarseness through part or the canpass of the voice; mininal damage 2 = moderate degree of hoarseness, and/or hoarseness throughout the whole ccmpass of the voice; moderate damage 3 = great degree of hoarseness, and/or inability to phonate throughout normal voice range You are also asked to identify the pitch level at which the subjects change from chest voice in the ascending scale passage. In sane cases, because of the lack of musical experience on the part of nearly all the subjects, it will not be possible to pin point the precise pitch at which this register change occurs. In those instances, merely indicate the pitch nearest where you believe the change takes place. In other cases, the subject may not actually make a register change, but sing the entire ascending scale passage solely in chest voice, or solely in head voice. In such cases, please write a note to that effect in the space beneath the notated musical scale. 42 Name APPENDIX B AUDITOR SCORE SHEET 44 H o Aooo odouwov Amy magmasoo who>omum .ovahoooanm A .powflfimua .oooonov wmwsmo mo oohmmn AS Asopwm mpwwnmonmmw waohwov "pm ooHo> pmwno Hose mmodno Aer ; etdm'es 45 APPENDIX C STATISTICAL ANALYSIS 46 STATISTICAL ANALYSIS tftest for independent means A - cheerleaders; ease canputation. B = control group. Decimals are removed to A B A2 B2 (N1) (N2) (N1) (N2) 1. 14 O6 196 36 2. 30 02 900 4 3. 01 04 1 16 4. 26 10 676 100 5. 14 08 196 64 6. 13 07 169 49 7. 23 07 529 49 8. 05 06 25 36 9. 22 30 484 900 1o. 09 04 81 16 11. 09 05 81 25 12. O8 03 64 9 13. 09 03 81 9 14. 01 06 1 36 15. 3o 09 900 81 16. 3o 02 900 4 17. 03 12 9 144 18. 20 15 400 225 19. 20 01 400 1 N1 N2 N1 N £X=287 £x=14o 1x=6o93 £X=1804 N = 19 l le — 287 N2 2 x = 140 N1 = 15.1 7 N2 = 7.37 X l 2 (lxN ) = 82369 2 (sz )2 = 19600 47 S = 6093 - 82369 + ' 19 36 2 s = 6093-4335.26 + 36 s2 = 1757.74 + 772.43 ' 36 s2 = 1530.17 36 s t = 15.1 - 7.37 42.50 + 42.50 ‘19 19 u——————._.———__————————————————————— the cheerleaders' voices to be significantly nore 59-9416 than the voices of the control group. APPENDIX D LETTER TO SUBJECTS 51 Eastern Michigan University YpsflantL Adhflfigan 48197 Paul Bravender Director, Opera Workshop Dear MS . Thank you for your participation in the study of cheerleading and its effect on the human voice. As a part of this study, Dr. Y. P. Kapur, M.D., a Laryngologist associated with the Speech and Audiology Clinic of Michigan State University, has agreed to examine the throats of participants, free of charge. This examination is indicated in your case because it has been determined by specialists that you are one of eight subjects who exhibit signs of vocal strain. These specialists expressed concern and asked that those showing vocal strain be examined medically, that this condition might be corrected. Dr. Kapur holds clinics on Monday afternoons from 1:00 to 3:00 at the Speech and Audiology Department on the Campus of Michigan State University. He has asked that these examinations be reserved on either Monday, October 4, or Monday, October 11. Please call the above department at Michigan State University at your earliest convenience, to reserve an appointment. The number is (517) 353—8780. If you have any questions in this regard, please call me at (313) 487—3414 (office) or (313) 482—3093. Sincerely, 7,0 (:Eiflvzflllimadvedék/ Paul Bravender I: M Department of Music (313)487-0244 52 APPENDIX E REPORTS FROM LARYNGOLOGISTS 53 ROGER W. MILLER, M.D. 27 South Prospect Street Surgery Of the Ypsilanti, Michigan 48197 Ear, Nose, Throat Head and Neck TELEPHONE 487-5357 November 4, 1976 Mr. Paul Bravender 209 Alexander Eastern Michigan University Ypsilanti, Michigan 48197 Re: Lois Brown Dear Mr. Bravender: Lois Brown was evaluated today with regard to your study. Indirect laryngoscopy reveals bilateral submucosal thickening of both vocal cords at the junction of the anterior and middle thirds of the cords. There is no evidence of erythema or other acute reaction in the area. The finding is compatible with so called singers nodules due to chronic voice abuse. I hope that the above information is of assitance. Si erely, -47" M41435 \ Roger W. Miller, M.D. 54 55 OTOLARYNGOLOGY SERVICES of the Audiology and Speech Science Department Speech and Hearing Clinic Audiology and Speech Sciences Michigan State University East Lansing, Michigan 148824 Telephone: 353-8780, extension 28 History No. 93699 Name: 391"“ [Eu/{0‘46 Age: 3‘ 3O 57 /£§/7’ ”(Mn fi- J[L7/lu[0n,m.c qfd/(J Referred by: HISTORY : - & q wmomm. a... w Q/A/iw 7&4 tweaks“ / _ . WWW W W ‘\ RMn/Q 56 HISTORY Date Taken Informant 13 Family History (blood relatives) Comments: (circle 1 or more) O-No history of allergy or deafness l-Allergy 2-Deafness (due to infection) 3-Deafnesa of obscure origin 4-Mcdication during pregnancy (specify) S-Rh incompatibility 6-Rubella in mother during pregnancy 7-Others 14 e ng Impairment (circle 1) 0- history of . -Periodic mild (questionable) Z-Periodic but definite 3-Definite but not within past year 4-Constant and within past year S-Constsnt and severe 6-No definite evidence of hearing at any time 15 ch (circle 1) g O-§o abnormalities noted -No attempts at phonation Z-No 3 word phrases (over 30 months of 81:6) I 3-Articulatory defect h-Phonatory defect not as severe as l or 2 S-Stuttering 6-Communicative defect 16 Tinnitus é Vertigo (circle 1) O-No history of l-Tinnitus Z—Vertigo 3-Tinnitus & Vertigo l7 Infections (circle 1) (gfifip history of -Ear aches, not within past year Z-Ear discharge, not within the past year 3-Ear aches without discharge in past ear 4-Ear discharge within past year 5-Chronic disehurge (over 6 weeks inactive) - o unusual upper respiratory symptoms 6-Chronic discharge (over 6 weeks active) 182:): and Sinuses (circle 1) 0% Q/Q’QQ/ 0 3-As in 1 plus chronic nasal obstruction S to 6 colds a yr. or 2 to 3 lasting 3 weeks or more (not within past yr.) 2-As in 1 but within past year M . \A t d 4-As in 1 plus chronic purulent discharge S-As in 1 plus chronic productive cough 57 O-No history suggestive of tonsillitis l-Pever, sore throat, swollen neck glands (not within past year) Q 991"“ '9' M Z—Fever with colds during past year ~ £9::}Vd 20 B.N.T. Surgery (circle 1) DATE _B_Y 1mm ”(ii/W ' O-None JL9L/3xrhxi' l-Adeaoidectomy ‘ 2-T&A m w M WJIM 3-Mastoidectomy rt. 4-Mastoidectomy 1t. S-Mastoidectomy bilateral 6—Sinus Operation 7-Submucous resection l9 Tonsils (circle 1) rComments: 8-Myringotomy 21 Infectious Diseases (circle 1 or more) DATE O-None l-Meningitis Z-Mumps 3-Measles 4-Whooping Cough S-Rubelle 6-Chicken Pox 7-Scarlet Fever 8-Syphilis 9-Other (specify below) 22 H63} eness slated to voice strain 2-Periodic 3-Continuous {less than 6 weeks) (:;}-{3,€_ CZ/(4a 4-Continuous (more than 6 weeks) S-Related to upper respiratory infection 6—Accompanied by cou 7-Accompanicd by chest infection 23 Allergies O-None l-Hay fever Z—Asthms 3-Food Allergies A-Skin Allergies S-Bcuts of sneezing only 6-0thers: 58 PHYSICAL swimmer (Contd .) #0 NASOPHARYNX {Circle 1) 0 Normal 1 Small midline adenoids 2 Adenoids L‘ upon tubal orifices 3 Large adenoid§J_£ubal orifices obscured A Nasopharynx. full of adenoids S Nasophnrvnx. obscured by pus b Tubal orifices ‘ ‘ LARYNX (Ci'cle one for each side) TEE nunnnrinl nhnnrmnlitv A, h . .n “1” ml nodules Wears:— . ocal polyp . Li J h 1» Acute laryngitis ,2/V\}\11A}Lk44 “*5- v 3hronic laryngitis k U 4 Jaralveis nnilnrnral I) P1r’ o L__ ’arnlysis , bi lat-oral WWW» W m I 8 Sontact ulcer u ? ) K3 0 a. 4n A A .______-___.___._._.___ ”M W 0&1 ’W M [A LRJLU _ TEMPORAL BONES X—MYS Rt. at. 45 A6 onmal b lletstnirlitis ( r1nrnn 1 n -1 "ssicular nml‘ h h racture of temporal bone 1‘ A1 *1 ‘fu nuinn‘n ( idening of internal auditory an; -mna by Du, 8 ' be studies 59 OTOLARYNGOLOGY SERVICES of the DEPARTMENT OF AUDIOLOGY & SPEECH SCIENCES, MSU Speech and Hearing Clinic Audiology and Speech Sciences Michigan State University East Lansing. MI 48824 ‘Telephone: 353-8780, Ext. 28 History No. 995’}; [-7/44J ,, ‘ .Cu’w’fl. fairs/L L '~ '4" 44/ .44 } 39%?flmif ‘ ‘I q 404144444544 ,m w. 9.4 Referred b : _ y mafiuwmdét’ Name: Age: Mp HISTORY & CHIEF COMPLAINT: i’i/LLLM C-4.;43,Lo\ '— H L ix \ ‘ . . t . . . 4 , \ Nev " /\\_,'\.Cj\. “L; (\LIV’, C' Ck>__:) ~ _. LN'QCkQ‘Q/YUI‘O k‘érK/Ltt} 4x 4W hm é: «\ch i'“ NL/t'v‘cK-v AALMA. 76L ‘/ 1H: 1] li’k /]<4l,7{,4i\)fdi .{4i’3'0¢“1£"“C/fl 6O HISTORY Date Taken Informant 13 Family History (blood relatives) Comments: (circle 1 or more) o-No history of allergy or deafness l-Allergy ‘«,, *_ ' ' 2-Deafness (due to infection) Sg4~/\&_ijr ___ ”VAJLXL 1:1:3E3;L£ 3-Deafness of obscure origin 1 V E; , {:7 \ é-Medication during pregnancy . , , k- (specify) CLLL’VV- I MWK" ( S-Rh incompatibility é-Rubella in mother during pregnancy 7-Others 14 Hearing Impairment (circle 1) O-No Mbistory l-Periodic mild (questionable) Z-Periodic but definite 3-Definite but not within past year b-Constsnt and within past year S-Constant and severe 6-No definite evidence of hearing at any time lS/S\peech (circle 1) \O-No abnormalities noted l-No attempts at phonation Z-No 3 word phrases (over 30 months of age) 3-Articulatory defect b-Phonatory defect not as severe as or S-Stuttering 6-Communicative defect Tinnitus & Vertigo (circle 1) OLNo history of -Tinnitus 2-Vertigo [,3-T nnitus & Vertigo (7 Ear nfections (circle 1) 0- No history of \\‘l-Ear aches, not within past year 2- Ear discharge. not within the past year 3-Ear aches without discharge in past ear p- O b-Esr discharge within past year 5-Chronic discharge (over 6 weeks in- active) 6-Chronic discharge (over 6 weeks _ , ,(fl/W, active) ’fl'L’L ( {‘4'\f’ '\' 18/N33e\:nd Sinuses (circle 1) / I O No nusual upper respiratory symptoms 1- 5 t 6 colds a yr. or 2 to 3 lasting 3 weeks or more (not within past yr. ) 2-As in l but within past year 3-As in 1 plus chronic nasal obstruction 4-As in 1 plus chronic purulent rH erhnree J 61 Tonsils (circle 1) Comments: . O-No history suggestive of tonsillitis A 1’£A.S'( l-Fever, sore throat, swollen neck _ " “ ’fw glands (not within past year) I “@QgL”L| Z-Fever with colds during past year 3’1:\ 'L E.N.T. Surgery (circle 1) DATE gums O-None V l-Adenoidectomy 2-T&A 3-Hastoidectom rt. z’.‘ /’\ . ~ ‘ 4-Mastoidectom: 1t. //”1/1/\') (f:~’{*};fir“:~1‘li- S-Mastoidectomy bilateral 6-Sinus operation 7-Submucous resection 8-Myringotomy Infectious Diseases (circle 1 or more) DATE O-None l-Meningitis Z-Mumps 3-Measles A-Whooping Cough S-Rubella 6-Chicken Pox 7-Scarlet Fever B-Syphilis 9-0ther (specify below) Hoarseness O-None l-Related to voice strain l Z-Periodic ‘\ , h ._m_ 3-Continuous (less than 6 weeks) ”-7&\\" ’: \—L'34:;g‘c kj~i- A-Continuoua (more than 6 weeks) \ S-Related to upper respiratory infection 6-Accompanied by cough 7—Accompanied by chest intention Allergies O—None l-Hay fever Z-Asthms 3-Food Allergies 4-Skin Allergies S-Bouts of sneezing only 6-0thers: ) s . .351 62 PHYSICAL EXAMINATION \ fttnc!pal I‘MI“ nine - BARS Circl l,for each ear) R . K L’. Y 32 / 33 I lormal ‘ e (b cured rum 'h rkannr Drum l 4 'L l' . and Rorrnrtnd—mwlflm W J 5 ‘ middle ear ‘ J‘ otitis media 1 t Dry ner‘oration Prfnra ion with discharge 3 1 Acute Ozitis Media 3 thernal Otitis :ongenital Atresis .33 NECK GLANDS (Circle 1) lot palpably abnormal alpable but not markedly enlarged ioderste to severe Pn‘ 55 TEHTI AND MOUTH lormaL Nv-‘o dent a ‘ enta caries: Slight enta caries: Severe 4 evere gingivitis with dental caries evere gingivitis without caries 36 Tons LS g rclefl C1 4 Normal Ileanly removed ”age. not infected ‘sgs, infected 9 w' 1 1ypertrophied cute ‘ “" “ O U carring and retraction moderate 7 oigns of severe chronic infection 37 PHARYNX (Circle 1) 0 Normal 1 Acute granular pharyngitis 2 Chronic lymphoid bvner“‘afl‘- not 63 PHYSICAL EXAMINATION (Contd.) LARYNX (Circle one for each side) am /L. 43 0 4h ormal Luz \ ‘ l nhnnrmalitv i ocal nodules 3 ocal polyp I a cute laryngitis hronic larvnoi fig 1 arnlvnic unilateral w w :ontact ulcer aralvcic bilateral #4 64 OTOLARYNGOLOGY SERVICES of the DEPARTMENT OF AUDIOLOGY 5 SPEECH SCIENCES, MSU Speech and Hearing Clinic Audiology and Speech Sciences Michigan State University East Lansing, MI 48824 Telephone: 353-8780, Ext. 28 History No. WA”? 49% Wild c Age: 36 Name: 741er m ,4 (am/”UAW“ {CA 1mm Referred by V73”) Kym/pm HISTORY & CHIEF COMPLAINT: (\an (Dex/{cue 51W W \)V QJ'R )‘WLK -L\,\,<}5—+Vm .M tit/xx, (‘4’ v» {AMM‘ , om imp: OW 3mm! Aggie 1L ”.59” kt V; b0 9 , H— . \. -kLO (W'M/n c; ppm . p ‘ g P .3 1 . “AW’CWM (1.2-(X3 W UVQ ML §a\ ’LX'VW \\' (,1: Q—‘Ckflxdc Class on g LU» K261 other w; . I) . .. , - .— Crimean "Ki \AXM L'ctwiwk C4"! “v ”V" Os/DQL .._ - “Lu/"j ..—— / (,' 65 HISTORY Date Taken Informant 13 Family History (blood relatives) Comments: L / vb circle 1 or more) : L1 O-No history of allergy or deafness . C _ Atjyywr l—Allergy \,l // ,. . 2-Deafness (due to infectionsz)}:é;/ ) /’ f"f ' . réy' 3-Deafness of obscure origin " . L A-Medication during pregnancy AOA'LB’ (specify) ax S-Rh incompatibility 6-Rubella in mother during pregnancy 7-0thers laxflearing Impairment (circle 1) O-No history of » l-Periodic mild (questionable) Z-Periodic but definite 3-Definite but not within past year A-Constant and within past year S-Constant and severe 6-No definite evidence of hearing at any time 15 Speech (circle 1) O-No abnormalities noted l-No attempts at phonation Z-No 3 word phrases (over 30 months of age) 3-Articulatory defect b-Phonatory defect not as severe as l or 2 S-Stuttering 6;Communicative defect 16 Tinnitus & Vertigo (circle 1) O-No'history of .l-Tinnitus 2-Vertigo .3-Tinnitus & Vertigo lZ’Ear Infections (circle 1) KO-No/history of lear aches. not within past year "ZFEar discharge, not within the past year 3-Ear aches without discharge in past year A-Ear discharge within past year 5-Chronic discharge (over 6 weeks in- active 6-Chronic discharge (over 6 weeks ' i active) \\fv ’ 18,Nose and Sinuses (circle 1) , U “ O-Np unusual upper respiratory symptoms (Ik$_‘)“ 1-5 to 6 colds a yr. or 2 to 3 lasting ’ / 3 weeks or more (not within past yr.) //L4,’C ;\ _ FV‘ 2-As in l but within past year ,\ q 3-As in 1 plus chronic nasal obstruction /LL b A-As in 1 plus chronic purulent discharge 66 tonsils (circle 1) Comments: O-No history suggestive of tonsillitis l-Fever, sore throat, swollen neck glands (not within past year) 2-Fever with colds during past year 20 E.N.T. Surgery (circle 1) DATE 2! WHOM O-None l—Adenoidectomy 2-T&A 3-Mastoidectomy rt. 4—Mastoidectomy 1t. S-Mastoidectomy bilateral 6—Sinus operation 7-Submucous resection 8-Myringotomy 21 Infectious Diseases (circle 1 or more) DATE O-None l-Meningitis Z-Mumps 3-Measles A—Whooping Cough S-Rubella 6-Chicken Pox 7-Scarlet Fever 8-Syphilis 9-Other (specify below) 22 Hoarseness O-None l-Related to voice strain 2-Periodic 3-Continuous (less than 6 weeks) 4-Continuous (more than 6 weeks) S-Related to upper respiratory infection 6-Accompanied by cough 7-Accompanied by chest infection 23/Allergies ’ Q:None 'l-Hay fever Z-Asthma 3-Food Allergies 4-Skin Allergies S-Bouts of sneezing only 6-Others: 67 PHYSICAL EXAMINATION (Contd.) DIAGMS IS : : / 3‘th '1 u 1‘ ‘ _I ' _‘ . I : ' _ ‘ u. LKJK‘L-XL \‘cn UL S...—;\\,\,\)\.CL,\.K."\\:.\ .1- TW‘ \ "~51 UL. £1,le (LL/X l BIBLIOGRAPHY 69 BIBLIOGRAPHY Arnold, Godfrey E., M.D. "Vocal nodules and polyps: Laryngeal tissue reaction to habitual hyperkinetic disphonia," Journal of speech and Hearing Dis- orders, August 1962, Vol. 27, No. 3. Brodnitz, Friedrich S., M.D. "Vocal rehabilitation in benign lesions of the vocal cords," Journal of Speech and Hearing Disorders, February, 1958, Vol. 27, No. 4. Gilb, Stella S. Cheerleading, Pep Clubs and Baton Twirl- ing. ,Lexington, Ky., Hurst Printing Co., 1955. Greene, Margaret C. L. The Voice and Its Disorders. New York: The MacMillan Company, 1959. Jones, J. Loren. "What Happens in Singing," The Choral Journal, May, 1975. Loken, Newt. Cheerleading. New York: The Ronald Press Company, 1961. Rubin, Henry J., M. D. "The Role of the Laryngologist in Management of Dysfunction of the Singing Voice," NATS Bulletin, May, 1966. Vennard, William. Singing,the Mechanism and the Technic, New York: Carl Fischer, Inc., 1968. Wilson, D. Kenneth, Ph.D. "Children with vocal nodules," Journal of Speech and Hearing Disorders, February 1961, Vol. 26, No. 1. General References Ash, J.E. and Schwartz, L. "The laryngeal (vocal cord) node," Trans. Amer. Acad. Opthol. Oto—laryng., Volume 48, 1943—44, pp. 323—332. Berry, M., and Eisenson, J. Speech Disorders. New York: Appleton—Century—Crofts, 1956. 70 71 Equen, M. "Laryngeal tumors-voice recordings before and after operation," Ann. Otol., Rhin. and Laryng., Volume 50, 1941, pp. 776-782. Flatau, T.S. "Chirurgische und funktionelle Behandlung der Stimmlippenknoetchen mit besonderer Berueck- sichtigung der Frage der Berufschaedigung," Zschr. Laryngol., Volume 3, 1910, pp. 369-373. Friedberg, S.A., and Segall, W.H. "The pathologic anatomy of polyps of the larynx," Ann. Otol., Rhin., and Laryng., Volume 50, 1941, pp. 783-789. Jackson, C.L. "Vocal Nodules," Trans. Amer. Laryn. Assn., Volume 63, 1941, pp. 185—193. Lowenthal, G. "Treatment of polypoidal laryngitis," Laryngoscope, Volume 68, 1958, pp. 1095-1104. Mayoux, R., and Girard, P. "Les polypes de la glotta. Etude anatomique et pathogenique," Rev. de Laryng., Volume 60, 1939, pp. 159—165. Moore, C.P. "Voice disorders associated with organic abnormalities," in L.E. Travis, (Ed.), Handbook of Speech Pathology. New York: Appelton—Century— Crofts, 1957. Motta, R. "Voce parlata e cantata e polipi delle corde vocali," I1 Valsalva, 1942. Tarneaud, J. Le nodule de la corde vocale. Paris: Maloine, 1935. Vaheri, E. "Zur Klinik und Pathogenese der Stimmlippen- polypen," Acta Otolaryng.,Volume 29, 1941, pp. 273-286. Wells, W. "The significance of hoarseness," Ann. Otol., Rhin., and Laryng., St. Louis, Volume 49, 1940, pp. 99—112. West, R., Ansberg, M., and Carr, A. The Rehabilitation of Speech.(3rd ed.) New York: Harper, 1957. Withers, B.T. "Vocal nodules," Eye, Ear, Nose Thr., Mon., Volume 40, 1961, pp. 33-38.