Portuguese and voice: preliminary study on current views

If one could see the voice in its most infinite detail, like when one looks at cells under a microscope, one would see particles of air moving in the space where the voice is being propagated…

Vídeo 1. Visual representation of sound
(software SoundField criado por Svante Granqvist, Suécia)

The voice, like for any other sound propagating in the air, propagates by moving particles of air (white dots in the video). These particles create high and low pressure points by being compressed and decompressed. When repeated with a certain frequency and amplitude, these positive and negative pressure peaks originate sinusoidal waves. The sum of these waves represent the sound, which physical properties are dependent on its source physical characteristics. For the case of the voice, the sound source corresponds to the interruption of air passing through the vocal folds, hence the transglottal airflow. In this sense, and thinking in a rather simple way, one may consider the voice as airflow moving in an acoustical space that is the vocal tract.

But before carrying on discussing the physiological, acoustical and aerodynamical parameters influencing voice production, or before trying to appreciate the neurological mechanisms underlying the complex mechanisms involved in voice function, it seems important to understand what is the role of the voice to people.

APVoz, the Portuguese Association of Teachers of Voice and Professional Voice Users, carried out a preliminary investigation on what Portuguese think about their voice. This seems relevant as, in Portugal, the economical, sector employing a higher number of people is the services sector, precisely the one in which professional voice users are included.
In the United States (US), it is known that the voice is a tool-of-trade for about 30% of the working population [1]. What about in Portugal? What is the percentage of active population whose jobs depend on voice use and/or on specific vocal characteristics? What is the use of the voice to Portuguese? What do they do when hoarse? What musical vocal genre(s) do they prefer? To find out the answers to these (and to other) questions, APVoz carried out an online questionnaire which results are presented below.

Who participated?

A total of 524 responses were obtained, 68% (n=356) from females and 32% (n=168) from males, aged between 18 and 75 years old.
Coimbra was the district with higher number of responses (37%, n=194), followed by Aveiro (16%, n=84), Lisbon (11%, n =58) and Oporto (10%, n=52).

What was the most represented professional group?

Professional voice users were the most represented occupational group in this study (59%, n=309).

Figure 1. Percentage of respondents who are (or were) professional voice users and who belong (or belonged) to other professional groups that do not include professional voice users

Who are professional voice users?

Anyone who requires an intensive voice use or needs specific voice characteristics in their work is considered a professional voice user. Thus, this occupational group includes several professionals, ranging from teachers, singers, actors, broadcasters, journalists, clergy, telemarketers, sells people, lawyers, politicians and health professionals.

Similarly to what has been observed in other countries, such as South Korea [2] and Sweden [3], also in this sample of Portuguese professional voice users teachers are the most represented group (25%, n=131).

Figure 2. Distribution of responses by professional group

Does voice matter?

The voice is extremely important to the vast majority of participants (63%); no one has answered that the voice is not at all important.

Figure 3. Distribution of responses by voice matters

With respect to voice-related self-appraisal, there were answers of voice dislike; a similar behaviour was found concerning voice-related self-identity.

Figure 4. Distribution of responses by voice-related self-appraisal

Figure 5. Distribution of responses by voice-related self-identity



To the vast majority of these Portuguese (67%, n=355), the quality of their work is highly dependent on the quality of their voices, with a constant use of the voice throughout their daily-life (54%, n=28).

Figure 6. Distribution of responses by voice-related quality of work


Figure 7. Distribution of responses by voice use

Do these Portuguese care about their voices?

Given the above responses, it seems evident that the voice is important to many Portuguese; thus, one expects that Portuguese care about their voices, especially if they are professional voice users, as for this specific professional group, the risk of work-related voice disorders is comparable to the occupational risk of exposure to dangerous chemicals or to the sun [4]. Females are more exposed to work-related voice disorders than males (46.3% versus 36.9%) [5], and possess a higher prevalence of chronic voice disorders (20.9% versus 13.3%) [6]. These are partially related to morphological, functional and endocrine gender-related differences. For example, females require a significant higher number of vocal folds vibrations per second, as they have smaller vocal folds and, consequently, higher speaking and singing fundamental frequencies [7, 8]. In addition, female’s life-long biological development exhibits more frequent sex steroid hormone variations, and these seem to cause more voice changes in women than in men [9, 10].
Perhaps, such genre differences may also account for the increasing numbers of females (but not of males) in otorhinolaryngology (ORL) hospital clinics in Portugal observed between 2011 and 2016.

Figure 8. Number of ORL appointments in hospital clinics in Portugal, distributed by genre, between 2011 a 2016 (data by Portuguese Ordem dos Médicos)

However, this trend must be carefully interpreted; the increases number of female patients might not be directly related with an increase of voice disorders in the female population. ORL specialists do not exclusively diagnose and treat voice-related pathologies. It would be necessary to carry out a study on the distribution of voice-related disorders exclusively in order to understand this trend.
Perhaps such study would be of value, especially if one takes into account that the results of the present investigation are not representative of the Portuguese population. The “just enough care of the voice” reported by 40% of the respondents might be related to the fact that few were those reporting voice pathologies (present or past) (21%), or the need for an ORL appointment due to voice changes (26%).

Figura 9. Distribution of responses by voice care

When hoarse, what are the behaviours of these Portuguese?

When hoarse, these Portuguese choose to take pills for a sore throat (32%) or to drink a tea (26%) before seeing an ORL specialist (22%). About 10% would be silent, and some would whisper to be understood. These behaviours suggest a poor understanding of voice care; whisper can cause more damage to the vocal folds than trying to talk normally, despite hoarseness.

Figure 10. Adopted behaviours for hoarseness

To take care of the voice is important? And singing can be beneficial?

Patients with voice pathologies present lower quality of life as compared to patients with other types of diseases [11, 12]. This finding corroborates the need for understanding voice disorders and for promoting healthy voices, especially knowing that group singing can be therapeutical [13, 14] and a resource to promote public health [15, 16].

Singing is one of the most appreciated activities in the world. It largely contributes to personal satisfaction [17] and social integration, cohesion and wellbeing [18]. Singing promotes physical health [19]. For example, patients with aphasia recover motor abilities required in speech more rapidly and efficiently when following melodic intonation therapy [20]. Other benefits associated with singing include improvements in mental health [21, 22], psychological wellbeing [23] and emotional [24] and cognitive [25] development, especially in children [26].

Do these Portuguese like to sing?

When asked about singing voice self-assessment, 43% (n=225) of the respondents indicated that they do not like their singing voice, despite preferring to hear singing music as compared to instrumental music (39% versus 12%, respectively). Only about 33% (n=174) scored high for enjoying their singing voices.

Figure 11. Distribution of responses by singing voice self-assessment

Are these Portuguese interested in voice education?

A considerably high number of responses showed interest in having voice lessons (90%, n=472). Amongst possible reasons for this interest, improving voice projection (28%, n=156), having a healthy voice (19%, n=115) and learning how to sing (21%, n=110) received higher number of responses.

Figure 12. Reasons for being interested in voice lessons

There was an interest also for voice-related scientific aspects. The vast majority of participants answered that they would take their kids to a voice exhibition (84%, n=440). However, only half would be interested in acquiring scientific books about the voice (46%, n=241) or in buying interactive software about the voice (42%, n=220).

What can be concluded from this study?

The results of this preliminary survey suggest that the voice is of great value to more than half of the Portuguese who responded to this survey.
A significant relationship between voice quality and quality of work was reported, highlighting the importance of having an efficient voice for work and for daily-life activities.
A clear interest in voice education was demonstrated. It seems that there is room for voice improvement, to enrich voice-related self-identity and to improve voice efficiency and vocal health.

APVoz nurtures the voice as an essential denominator for promoting quality education, science, health, wellbeing, culture and leisure.
Your voice is also your identity: make it last all your life!

Where to look for more information?
  1. Titze I.R., Lemke J. & Montequim D. (1997). Populations in the U.S. Workforce Who Rely on Voice as a Primary Tool of Trade: A Preliminary Report. Journal of Voice, 11(3): 254-259.
  2. Byen H. (2017). Occupational risks for voice disorders: Evidence from a Korea national cross-sectional survey. Logopedics Phoniatrics Vocology, 42(1): 39-43
  3. Williams N.R. (2003). Occupational groups at risk of voice disorders: a review of the literature. Occupational Medicine, 53(7): 456-460.
  4. Titze I.R. & Svec J.G. (2003). Vocal Dose Measures: Quantifying Accumulated Vibration Exposure in Vocal Fold Tissues.Journal of Speech, Language, and Hearing Research, 46: 920-932.
  5. Hunter E.j., Smith M.E & Tanner K. (2011). Gender differences affecting vocal health of women in vocally demanding careers. Logopedics Phoniatrics Vocology, 36(3): 128-136.
  6. Roy N., Merrill R.M., Thibeault S., Parsa R.A., Gray, S.D. & Smith E.M. (2004). Prevalence of Voice Disorders in Teachers and the General Population. Journal of Speech, Language and Hearing Research, 47: 281-293.
  7. Klatt D.H. & Klatt L.C. (1990). Analysis, synthesis, and perception of voice quality variations among female and male talkers. Journal of Acoustic Society of America, 87: 820–857.
  8. Roers F. Mürbe D. &, Sundberg J. (2009).Predicted Singers’ Vocal Fold Lengths and Voice Classification—A Study of X-Ray Morphological Measures. Journal of Voice, 23(4): 408-413.
  9. Lã F. & Davidson, J.W. (2005). Investigating the Relationship between Sexual Hormones and Female Western Classical Singing. Research Studies in Music Education. 24: 75-87.
  10. Lã F.M.B., Howard, D.M., Ledger, W., Davidson, J.W. & Jones, G. (2009). Oral contraceptive pill containing drospirenone and the professional voice: an electrolaryngographic analysis. Logopaedics Phoniatrics Vocology, 34 (1): 11-19.
  11. Behlau M., Hogikyan N.D. & Gaspirini G. (2007). Quality of Life and Voice: Study of a Brazilian Population Using the Voice-Related Quality of Life Measure Folia Phoniatrica Logopedica: 59: 286-296.
  12. Cohen S.M., Dupont W.D. & Courey M.S. (2006). Quality-of-Life Impact of Non-neoplastic Voice Disorders: A Meta-analysis. Annals of Otology, Rhinology & Laryngology, 115(2): 128-234.
  13. Mellor L. (2013). An investigation of singing, health and well-being as a group process. Brithish Journal of Music, 30(2): 177-205.
  14. Bailey B.A. & Davidson J.W. (2009). Amateur Group Singing as a Theraopeutic Instrument. Nordic Journal of Music Therapy, 12(1): 18-32.
  15. Mellor L. (2013). An investigation of singing, health and well-being as a group process. Brithish Journal of Music, 30(2): 177-205.
  16. Bailey B.A. & Davidson J.W. (2009). Amateur Group Singing as a Theraopeutic Instrument. Nordic Journal of Music Therapy, 12(1): 18-32.
  17. Kreutz G., Bongard S. , Rohrmann S, Hodapp V, Grebe D. (2004). Effects of choir singing or listening on secretory immunoglobulin A, cortisol, and emotional state. Journal of Behavioural Medicine, 27(6): 623-635.
  18. Stacy R., Brittain K. & Kerr S. (2002). Singing for heatlh; an exploration of the issues. Health Education, 102(4): 156-162.
  19. Grape C., Sandgren M., Hansson, LO., Ericson, M. & Theorell T. (2003). Does Singing Promote Well-Being? An Empircal Studo of Professional and Amateru Singers during a Singing Lessons. Integrative Physiological & Behavioral Sience, 38(1): 65-74.
  20. Norton A., Zipse L., Marchina S. & Schlaug G. (2009). Melodic Intonation Therapy: Shared Insights on How It Is Done and Why It Might Help. The Neurosciences and Music III: Disorders and Plasticity. Annals of New York Academy of Sciences. 1169: 431-436.
  21. Greaves C.J. & Farbus L. (2006). Effects of creative and social activity on the health and well-being of socially isolated older people: outcomes from a multi-method observational study. The Journal of The Royal Society for the Promotion of Health, 126(3): 134-142.
  22. Clift S. & Morrison I. (2011). Group singing fosters mental health and wellbeing: findings from the East Kent ‘‘singing for health’’ network Project. Mental Health and Social Inclusion, 15(2): 88-97.
  23. Gick M.L. (2011). Singing, health and well-being: A health psuchologist’s review. Psychomusicology: Music, Mind & Brain, 21(1&2): 176-207.
  24. Bungay H., Clift S. & Skingley A. (2010). The Silver Song Club Project: A sense of well-being through participatory singing. Journal of Applied Arts and Health, 1(2): 165-178.
  25. Bilhartz T.D., Bruhn, R.A., Olsona E.J. (1999). The Effect of Early Music Training on Child Cognitive Development. Journal of Applied Developmental Psychology, 20(4): 615-636.
  26. Rausher F.H. (2003). Can Music Instruction Affect Children’s Cognitive Development? ERIC Digest: 1-7.