COVID-19: Impact on the Musician and Returning to Singing; A Literature Review.
Dylan Vance, Priyanka Shah, Robert T Sataloff
PMID 33583675WHAT IT FOUND
Singing and playing wind instruments generate far more aerosols than normal speech, especially at loud volumes.
Voice therapy exercises like straw phonation also spread droplets easily. Telemedicine is a viable alternative for many patients, though it limits laryngeal examination.
Key findings
01Singing produces significantly more aerosol mass than speaking at loud volumes, and vocalization emits up to an order of magnitude more particles than breathing.
02Semioccluded voice therapy exercises, such as straw phonation, create turbulent airflow that spreads respiratory droplets easily, requiring mask precautions that may compromise therapy quality.
03Telemedicine voice therapy outcomes are often not significantly different from in-person sessions, though it prevents necessary laryngeal examination for accurate diagnosis.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is a narrative review, not a systematic review with quality assessment or meta-analysis. The search was limited to 2019-2020, missing later variants and evidence. Much of the evidence on aerosol generation comes from studies not specifically designed for clinical voice therapy settings. Guidelines cited (e.g., from performing arts groups) are based on expert opinion and preliminary data, not tested interventions.
The easy way to misread this
Do not treat the aerosol generation data from singing studies as direct evidence for the efficacy or safety of specific voice therapy protocols. The review highlights transmission risks and logistical challenges, but does not test whether modified therapy techniques actually reduce spread or maintain clinical outcomes.