To the Editor Clarós et al1 should be complimented on the article “Association Between the Development of Pediatric Voice Disorders and Singing in Children’s Choir,” published online in March. The study was important. However, the authors might consider another explanation for their findings. Their article suggests an association between good vocal health and choir singing based on attention to healthy singing techniques in the Spanish choir tradition. Although I am a strong advocate of healthy choral singing,2 one should consider that their findings may have been a result of self-selection rather than vocal education. Voice disorders were twice as common in the nonsinging group; but there is no way to know from this study when those voice problems developed. It is likely that children with poor voices, especially those with pathologic voice disorders, would choose to avoid auditioning for a choir (or might be rejected if they did audition) and would gravitate toward extracurricular activities that are not dependent on good voice quality and endurance. So, although I (as a university choir conductor) would like to believe that there may be a causal relationship between choral singing and good vocal health, I do not believe that the data presented support that conclusion.
Sataloff RT. Association of Singing With the Development of Pediatric Voice Disorders. JAMA Otolaryngol Head Neck Surg. 2019;145(10):981–982. doi:10.1001/jamaoto.2019.1796
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